Mesh related vesico-peritoneal fistula presenting with urina
Published in the journal Urology Case Reports, the authors present a case of mesh related vesico-peritoneal fistula presenting with urinary ascites 2 years after incisional hernia repair.

A 48 year-old female patient was admitted to emergency department with nausea, vomiting and decreased urine output. She had a history of low anterior resection due to rectal cancer 5 years ago and laparoscopic incisional hernia repair with composite mesh 3 years ago.

Laboratory tests revealed an elevated creatinine level of 3,8 mg/dl. Patient was transferred to nephrology clinic with the diagnosis of acute renal failure. A Urethral catheter was placed and a Computed tomography was performed showing intraperitoneal free fluid accumulation.

Percutaneous drain was placed and analysis of peritoneal fluid revealed an increased creatinine level (14.42 mg/dl) indicating urinary ascites. A cystography was performed but no extravasation was observed. Patient’s creatinine level rapidly declined after catheter placement. Drain and catheter were removed 7 days after admission and patient was discharged.

Patient was admitted to emergency department with same complaints 2 months later. An immediate cystography was performed and severe contrast extravasation from dome of the bladder into peritoneal cavity was observed. Patient was transferred to urology clinic with the diagnosis of bladder fistula.

Key takeaways:-
• Vesico-peritoneal fistula should be suspected in patients with increased blood creatinine level and ascites especially if there is a history of previous abdominal surgery.

• Patient should be evaluated very carefully to prevent misdiagnosis of acute renal failure. Also, complications due to mesh migration should be kept in mind in patients with hernia repair.

• Cystography is most of the time diagnostic and should be done before or as soon as possible after catheter placement but when inconsistent, cystoscopy should be performed to assess integrity of bladder.


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