Iatrogenic vesicocolic fistula after gynecologic surgery: a case report

Introduction and importance: We present a unique case of a vesicocolic fistula (VCF) that occurred postoperatively after ovarian cyst surgery, caused by the migration of an intraoperatively forgotten gauze into the urinary bladder. This represents a very rare etiology of VCFs. Case presentation: A patient who had undergone surgery for a giant left ovarian cyst 5 months prior presented with recurrent urinary tract infections and an ultrasound image suggestive of a bladder stone. Cystoscopy, contrast-enhanced computed tomography, and colonoscopy confirmed a VCF with an intravesical foreign body. Surgical management consisted of fistula excision, removal of the gauze, bladder repair, and definitive colostomy. Postoperative evolution was favorable, and the patient remained infection-free at 1 year. Clinical discussion: VCFs are most frequently associated with diverticular disease, whereas iatrogenic causes - particularly due to retained surgical gauze - are extremely rare. This case highlights the diagnostic difficulty when symptoms mimic more common conditions such as recurrent urinary tract infections or bladder stones. Early suspicion of a fistula is crucial in patients with persistent urinary symptoms after pelvic surgery. Management depends on patient factors, comorbidities, and fistula etiology; in this case, advanced age warranted a conservative two-stage approach with a permanent colostomy. Conclusion: In patients with recurrent urinary infections after pelvic surgery and imaging suggestive of bladder stones, clinicians should consider VCF due to migrated foreign bodies in the differential diagnosis.