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Indian Journal of Medical Sciences, Vol. 59, No. 1, January, 2005, pp. 30-31 Letter To Editor A rare case of vesicovaginal fistula following illegal abortion Puri Manju, Goyal Uma, Jain Sandhi, Pasrija Shikha Departments of Obstetrics and Gynaecology, Lady Hardinge Medical College and Associated Hospitals, New Delhi Code Number: ms05007 Sir, It is estimated that 50-60 million induced abortions take place annually in the world and 19 million are still performed illegally.[1] According to WHO, about one quarter to one third of maternal deaths are due to complications of induced abortion. The morbidity and mortality related to criminal abortions is due to complications like haemorrhage, perforation, sepsis, shock and visceral injuries. Bladder injuries due to instrumental perforation of the uterus have been reported,[2] but development of a urinary fistula without any instrumentation in induced abortion is rare. We came across such a presentation. A 35-year, P5A1L5, illiterate woman presented with continuous dribbling of urine per vaginum following an illegal abortion at 3 months of gestation by a quack, 7 months back. According to her some paste was applied in the vagina following which she aborted spontaneously and noticed watery discharge per vaginum. She consulted a doctor for persistent vaginal discharge and was diagnosed as a case of vesicovaginal fistula. Earlier Obstetrc history was uneventful. Her menstrual cycles were normal, however following abortion she developed amenorrhoea. Abdominal examination was unremarkable. Speculum examination showed a blind vagina, about 6 cm long. Cervix could not be visualized. A small opening (6 mm in diameter) about 4.5 cm from the urethral meatus was seen at the vault. On bimanual examination, vagina ended blindly with cicatrization in upper part, cervix could not be felt. The margins of the fistula were fibrosed and irregular. On per rectal examination uterus and cervix could not be appreciated properly instead a transverse band was felt. All routine investigations were normal. Urine pregnancy test was negative. Intravenous pyelography and cystoscopy confirmed vescicovaginal fistula. The kidneys and ureters were normal. On ultrasonography a very small cervix and uterus with a thinned out endometrial lining was seen. Adnexae were normal. On diagnostic laparoscopy uterus was not visualized due to dense adhesions Pouch of Douglas was obliterated. Round ligaments, tubes and ovaries were seen. Serum FSH, LH, Prolactin and TSH levels were within normal limits. Repair of the fistula was done vaginally by layer method, and the patient discharged after 2 weeks. Despite the MTP act, which legalised abortions in India way back in 1971, the number of illegal abortions is still very high (28%)[3] and forms the tip of an iceberg. It accounts for many maternal deaths (41%).[4] Lack of awareness and knowledge about MTP as well as various contraceptive methods, easy accessibility of quacks at their doorstep and non availability of recognised MTP centers and trained personnel are some of the factors towards which action is required to ensure safety and boost up the National Family Welfare Programme. REFERENCES
Copyright 2005 - Indian Journal of Medical Sciences |
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