Arteriovesical fistula: a complication of bladder trauma

Pelvic gunshot wound presenting as bladder clot concealing a left external iliac injury

Key clinical message

This is the first reported case of a pelvic gunshot wound with a bladder injury masking a coinciding left external iliac artery injury. A high index of suspicion for an acute and traumatic ilio-vesical fistula should be raised in the presence of the following triad: bright red hematuria, bladder distension from clot retention, hemodynamic instability after bladder decompression "Mukendi's triad."

Abstract

Iliac artery injury from gunshot wounds is very rare and a lethal injury associated with high mortality rate. Concurrent ballistic external iliac artery and bladder injuries resulting in an acute ilio-vesical shunt or fistula and discovered at the time of presentation are extremely rare.In this report, we present an unprecedented case of multiple pelvic gunshot wounds presented with a distended injured bladder full of clots concealing a left external iliac injury by tamponade effect.

Frank haematuria secondary to ruptured pseudoaneurysm of the inferior vesical artery: a case report and review of the literature

Background

Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria.

Case presentation

A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization.

Conclusion

Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.

Femoral pseudoaneurysm rupturing into urinary bladder: A rare presentation

Femoral pseudoaneurysm is a common occurrence in intravenous drug abuser due to repeated trauma to the femoral artery causing arterial leak contained by the surrounding tissue and does not contain all the layers of arterial wall. Rupture of these aneurysm to exterior is a common presentation while rupture into surrounding structure deemed an emergency surgical attention. Hence, we report an unusual case of rupture of femoral pseudoaneurysm into urinary bladder who presented us with history of hematuria and was successfully managed.

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula

Background

Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously.

Case presentation

We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization.

Conclusions

Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation.

Arteriovesical fistula as a complication of a gunshot wound to the pelvis: Treatment dilemma

The case is reported of an arteriovesical fistula after a gunshot wound to the pelvis in a 29-year-old man. It developed 20 days after an exploratory laparotomy with primary suture of the bladder. The patient presented with intermittent gross hematuria and diagnosis was made through cystoscopy and arteriogram. Treatment was initially performed through open embolization. Re-treatment with endovascular procedures was twice necessary. Further evolution led to complete recovery from symptoms after an open procedure. Virtually all forms of treatment were tried and the resolution was finally achieved after more than 7 months.

Abberant sex habits leading to acute limb ischemia and hematuria

We report a case of a 42 year-old man suffering from an acute limb ischemia. Upon urokinase treatment he developed gross hematuria. Finally, CT scanning revealed a self-inserted foreign body not only causing thrombosis of the external iliac artery, but also forming an arteriovesical fistula. This case emphasises the importance of detailed history taking and thorough further investigation in recurrent macroscopic hematuria in a patient. Massive bleeding from the bladder should alert the doctor for a rare, but life-threatening arteriovesical fistula.