Herniation of Amniotic Sac from Urethra as a Unique Presentation for Vesicouterine fistula (VUF): A Case Report

Abstract

Background Among all urogenital fistulas Vesicouterine fistula (VUF) is the rarest. The most common cause of VUFs is a previous cesarean section. We report a patient with a unique presentation of VUF, which is a protruded amniotic sac through urethra. Case presentation A 29-year-old woman in her fifth pregnancy presented to the emergency department at 24 weeks gestation with an abdominal pain and a sac protruding from vulva during urination thinking she was aborting. The pelvic examination revealed a thin-walled fluid-filled 5 cm × 5 cm- sized clear serous sac protruding from her urethra with no connection of the cervix or bleeding. Gynecologic examination showed partial cervical canal dilation without bleeding or leakage of amniotic fluid. Based on the clinical and ultrasound findings, we suspected a uterine and bladder rupture with the amniotic sac protruding from the urethra, therefor an emergency cesarean section was done. During the procedure, we addressed the fistula and The patient was discharged after a two-day recovery period. Conclusions Vesicouterine fistulae could interfere with many other disorders and should be considered as a differential diagnosis in every woman with a protruding amniotic sac.