Atypical presentation of vesicouterine fistula (Youssef’s syndrome) post-caesarean gossypiboma: a case report

Abstract

Vesicouterine fistula as described by Youssef manifests with amenorrhea, and cyclic haematuria (menouria) without urinary incontinence commonly following caesarean section. Other aetiologies have been reported for this disease. The post-caesarean section gossypiboma, a dual aetiology causing this condition is rare and can make its presentation atypical, thus posing a diagnostic dilemma. The clinical evaluation alone in the atypical presentation of the vesicouterine fistula is insufficient except complemented by imaging investigations and endoscopic examination of the related organs. We report a case of vesicouterine fistula that was managed initially as chronic pelvic inflammatory disease despite urinary incontinence until further evaluation including a transvaginal ultrasound scan and urethrocystoscopy raised an index of suspicion of a vesical mass suggestive of gossypiboma. The mass was confirmed to be a foreign body, an abdominal gauze pack, or gossypiboma. Its removal and repair of the vesicouterine fistula were associated with a satisfactory outcome.