Pregnancy in a patient with a vesicouterorectal fistula and obliterated vagina: A case report

BACKGROUND: Pregnant women with obstetric fistula are at high risk for obstetric complications and present a unique challenge in management. CASE: A young, HIVpositive woman with a history of rectovaginal and vesicovaginal fistulae after a prior delivery presented in premature labor. Upon cesarean delivery, fecal matter entered the uterus. The uterus was irrigated, closed, and a sigmoid colostomy was created. Subsequently, she underwent repair of both fistulae with bilateral ureteral reimplantation, hysterectomy, primary rectal repair, and colostomy reversal. She remains continent of urine and stool at 6 months' follow-up. CONCLUSION: Obstetric fistula patients who conceive must be followed closely for obstetric complications and offered timely cesarean delivery.