After total abdominal hysterectomy, a patient has continuous watery vaginal discharge from the 5th postoperative day. Intravenous indigo carmine is given and a vaginal swab is soaked with blue dye. The most likely diagnosis is:

• A Vesicovaginal fistula
• B Ureterovaginal fistula ✓
• C Urethrovaginal fistula
• D Vaginal vault cellulitis

Explanation

IV indigo carmine stains urine of ureteric origin blue. Blue dye on vaginal swab after IV indigo carmine confirms ureteric communication with the vagina. Vesicovaginal fistula is diagnosed by intravesical methylene blue (not IV). Ureteric injury is a recognized complication of hysterectomy due to the close anatomical relation of the ureter to the uterine artery.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.