Quiz - Feb 2013

Author(s): Zorina Walsh, Nancy MacKeith and David Tibbutt compiled this quiz. We thank Brian Hancock, MD, FRCS, FRCOG (Hon.), Visiting Fistula Surgeon to Uganda for the photograph.

Spot diagnosis and Quiz

A woman aged 25 years was admitted because of a post-delivery problem following a prolonged labour. This picture was taken at the time of the investigation:



(credit: Brian Hancock)



  1. What is the diagnosis?
  2. What is the significance of the purple dye (arrowed) appearing in the perineum?
  3. What is the most likely cause of the problem?
  4. What is the treatment?
  5. What is the social consequence before and after successful management?


 Scroll down for the Answers...
















  1. Vesico-vaginal fistula.
  2. Dye has been instilled into the bladder through the urethral catheter and then leaks out into the vagina to confirm a vesico-vaginal fistula.
  3. Prolonged obstructed labour leading to tissue necrosis between the vagina and bladder and the formation of the fistula. Urine then leaks into the vagina and the patient has no control.
  4. Surgical repair.
  5. Rejection by society because of the unpleasant smell that accompanies constant leakage of urine. With successful repair this problem is resolved.