Abstract
A patient in her late 20s presented with a month-long history of continuous dribbling of urine associated with right flank following suction-evacuation for an incomplete abortion. Contrast-Enhanced Computed Tomography (CECT) abdomen and Computerised Tomography (CT) urogram demonstrated a 1cm focal defect in the right lateral wall of the uterus communicating with a collection in the right hemipelvis and right paracolic region. Fluid was demonstrated in the uterus and cervix. The right ureter narrowed abruptly at the level of the S1 vertebra, with prominence of the proximal ureter. An opacified tract was seen between the right ureter and the uterus [Figures 1, 2 and 3] diagnosed as a fistula. The patient had a total laparoscopic hysterectomy with ureteric reimplantation into a Boari flap surgery and psoas hitch of the urinary bladder, with the clinical application of pre-operative 3D CT imaging allowing for surgical improved planning to optimise the outcome [Supplemental Figure 1].
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