Case notes
An 84-year-old woman with a chronic indwelling Foley catheter for urinary incontinence was sent to the emergency department after 24 hours of gross hematuria. The patient was otherwise asymptomatic and denied fever, chills, dysuria, or any other pain. Urinalysis revealed the following: pH, 8; leukocyte esterase, 3+; and blood, 3+. A microscopic examination showed 12 white blood cells/high-power field, 5 red blood cells/high-power field, and many squamous epithelial cells. Mixed bacterial flora grew on a urine culture. Since the hematuria continued, a urinary cystogram was performed, and this disclosed a salpingovesical fistula–a communication between a fallopian tube and the bladder ( Figure ).
Urinary cystogram identified cause of patient’s symptoms.
Ta. A problematic pathway. Am J Obstet Gynecol 2012.
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