case_images: PMC11152545_01
case_images: Preoperative abdominal computed tomography scan with intravenous and per os contrast. (a) Sagittal cut demonstrating the subcutaneously implanted baclofen pump, the surrounding pus and inflammation (white arrows) and the exit point of the proximal vesicocutaneous fistula (white asterisk). (b) Axial cut showing the exit point of the suprapubic midline vesicocutaneous fistula (white asterisk).
case_images: SNI-15-185-g001.jpg
case_images: PMC11152545_01_SNI-15-185-g001.jpg
case_images: F1
case_images: The UTIs, in conjunction with the history of cesarean section and bladder overfill, lead to the formation of a vesicocutaneous fistula (fistula connecting the urinary bladder to the skin) at the midline of the lower abdominal area 6 months ago [Figure 1a]. Two weeks before her admission to our Clinic, a second fistula was formed, which was in close proximity to the implanted baclofen pump [Figure 1a]. Hence, the patient was treated medically and underwent an abdominal computed tomography (CT)-scan, which revealed a collection of fluid surrounding the baclofen pump [Figure 1b].
case_images: (a) Suprapubic midline vesicocutaneous fistula (black arrow), proximal vesicocutaneous fistula (white arrow) to the pump pocket and skin erythema (black asterisks) surrounding the implantation scar. (b) Intraoperative picture of the pump pocket filled by the empyema. (c) Evacuated pus from the pump pocket.
case_images: SNI-15-185-g002.jpg
case_images: PMC11152545_01_SNI-15-185-g002.jpg
case_images: F2
case_images: Her physical examination revealed a tense baclofen pump pocket with overlying redness of the skin [Figure 2a]. During the operation, empyema was confirmed [Figure 2b], and approximately 80 mL of inflammatory fluid were evacuated from the pocket [Figure 2c].