Quiz - Feb 2013
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)
- What is the diagnosis?
- What is the significance of the purple dye (arrowed) appearing in the perineum?
- What is the most likely cause of the problem?
- What is the treatment?
- What is the social consequence before and after successful management?
Scroll down for the Answers...
- Vesico-vaginal fistula.
- Dye has been instilled into the bladder through the urethral catheter and then leaks out into the vagina to confirm a vesico-vaginal fistula.
- 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.
- Surgical repair.
- Rejection by society because of the unpleasant smell that accompanies constant leakage of urine. With successful repair this problem is resolved.