A 42-year-old multipara undergoes an elective total abdominal hysterectomy for symptomatic uterine fibroids. On postoperative day 5, she develops watery fluid drainage from the vagina. Intravenous indigo carmine dye is injected, and blue staining is observed on a vaginal swab within 15 minutes. What is the most likely iatrogenic injury and the definitive diagnostic imaging modality to confirm the diagnosis?
Answer and explanation
Correct answer: B. Ureterovaginal fistula; CT Urography or cystoscopy with retrograde pyelogram
- Step 1: The ureter courses directly beneath the uterine artery near the internal cervical os ('water under the bridge'), making it highly vulnerable to inadvertent transection, clamping, or devascularization during hysterectomy.
- Step 2: Postoperative vaginal leakage of urine (confirmed by blue staining after intravenous indigo carmine or oral phenazopyridine) indicates a urinary tract fistula (ureterovaginal or vesicovaginal).
- Step 3: CT Urography (with delayed excretory phase imaging) or cystoscopy with retrograde pyelogram accurately pinpoints the site and extent of ureteral or bladder injury.
Answer
Ureterovaginal fistula; CT Urography or cystoscopy with retrograde pyelogram.
Why not the others: 'Rectovaginal fistula' causes fecal and flatus leakage per vaginam, not clear watery urine stained by indigo carmine; 'Peritoneal fluid leak' does not concentrate intravenous indigo carmine dye; 'MRCP' images the hepatobiliary and pancreatic ducts, having no utility for pelvic urinary tracts.
Practise more Obstetrics, Gynecology, and Medical Ethics & Safety.
Free questions with an explanation for every one, and full timed Kuwait Medical Licensing Examination (KMLE / KIMS) mock tests.
More Obstetrics, Gynecology, and Medical Ethics & Safety questions
- A 32-year-old primigravida at 34 weeks of gestation presents with a severe frontal headache, visual blurring, and epigastric pain. Her blood…
- A 28-year-old woman at 38 weeks of gestation undergoes uncomplicated spontaneous vaginal delivery of a 4,100 g infant. Ten minutes after pla…
- A 31-year-old multipara at 32 weeks of gestation presents to the labor ward with sudden-onset, painless bright red vaginal bleeding. She den…
- A 24-year-old woman presents to the emergency department with acute right lower quadrant abdominal pain, light vaginal spotting, and 7 weeks…
- A 30-year-old pregnant woman at 26 weeks of gestation undergoes routine screening for gestational diabetes mellitus (GDM) with a 75 g 2-hour…
- A 29-year-old primigravida at 30 weeks of gestation presents with sudden watery fluid leakage from the vagina. Sterile speculum examination…