Delayed vesicovaginal fistula after abdominal hysterectomy attributed to oxidized regenerated cellulose: a case report

Abstract

Vesicovaginal fistula (VVF) is a distressing complication following hysterectomy. While most cases result from direct surgical trauma or tissue devascularization, delayed fistula formation secondary to foreign body reaction is uncommon. Oxidized regenerated cellulose, widely used as a topical haemostatic agent, has occasionally been associated with inflammatory complications when placed adjacent to hollow organs. A 45-year-old woman without comorbid illness underwent total abdominal hysterectomy for symptomatic adenomyosis. Intraoperative dye testing confirmed bladder integrity. Minor vault bleeding was controlled using oxidized regenerated cellulose. Thirteen days postoperatively, she developed intermittent urinary leakage per vagina, noticeable when the bladder was distended. Retrograde dye testing demonstrated a small vesicovaginal fistula. Magnetic resonance urography confirmed contrast passage into the vagina. Computed tomography revealed multiloculated cystic lesions along the superior bladder wall, suggestive of inflammatory reaction to retained haemostatic material. Initial management included continuous bladder drainage, followed by definitive surgical repair after three months, resulting in complete recovery. Delayed VVF related to oxidized regenerated cellulose is rare but preventable condition. Careful placement of absorbable haemostatic materials near hollow viscera and early recognition of postoperative urinary leakage are essential to reduce morbidity associated with it.