Haemorrhagic Shock Secondary to an Ilio-Ureteric Fistula

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Introduction: Ilio-ureteric fistula is an abnormal communication between an artery and the ureter. It presents as paroxysmal haematuria. Risk factors include aorto-iliac vascular surgery, ureteric stenting and pelvic cancer treatments. Case Description: A 70-year-old woman with CKD stage 4 from obstructive uropathy due to cervical cancer (post-radiotherapy) presented with right flank pain and haematuria. She had a nephroureteric stent in situ. She developed haemorrhagic shock. Imaging showed an iliac artery–ureter fistula. A covered stent sealed the fistula, and the ureteric stent was exchanged for a new nephroureteral stent. Discussion: Ilio-ureteric fistulas are rare, potentially fatal, and may be underdiagnosed. Mechanisms and management are discussed.Formal angiogram demonstrated that the right external iliac artery was abnormally communicating and filling the right ureter, with retrograde filling of the right renal pelvis representing abnormal fistulisation here.A repeat diagnostic angiogram post stent insertion showed no further communication with the right ureter. The right ureteric stent was then removed, and again repeat angiogram showed no retrograde filling or communication with the right ureter.

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