Fractures of the pelvis are typically the result of high-energy trauma and place patients at risk of associated bladder, urethral, and vaginal injury [3,4].

This Genito-urinary injuries account for 6% in the United States [1] and 2.63% of urogenital fistulas in Africa [5]. The increasing incidence of injuries to the urogenital tract associated with sequelae is caused by a growing number of pelvic ring fractures and, more importantly, by reduced mortality in patients with severe trauma to the pelvic ring [2].

Extraperitoneal rupture of the bladder most commonly occurs when the bladder is lacerated by a sharp, bony spicule. Injury to the bladder or urethra most commonly occurs in association with significant anterior ring disruptions, most commonly pubic ramus fractures [6].

Pelvic fractures often occur by high energy trauma and have a significant mortality rate, with a frequency ranging from 8 to 15% [7,8].

Rothenberger pointed out that 66% of injured people who died of pelvic fractures died of haemorrhage [9]. In our case, a bilateral internal iliac artery ligation was done in front of a massive retroperitoneal haemorrhage. It should be remembered that in our present case, this ligation very probably saved this young patient's life but was complicated by the development of an eschar of the left gluteal muscles.

The principle of hypogastric arteries ligation is based on tying the anterior trunk of the hypogastric artery about 2 cm from the iliac bifurcation in order to preserve the posterior gluteal branches. It can reduce haemorrhage in 40-100% of instances, but it nevertheless has a poor surgical reputation due to the difficulty of the procedure and the associated morbidity [10].

No case of vesico-vaginal fistula occurring in a traumatic setting after ligation of the hypogastric arteries has been reported. We exclude this aetiology, but nevertheless consider it to be an aggravating factor that delays spontaneous closure of vesico-vaginal fistula under bladder catheterisation alone.

When haematuria and vaginal bleeding occur after pelvic fracture, the diagnosis of genitourinary trauma is clinically suspected; however, because the patient's vitals and life-threatening risks were prioritized, their genitourinary injuries were frequently ignored in the emergency room during the primary trauma. Reports have noted that initial emergency department assessment can miss this diagnosis in as many as 40% of cases [1].

The timing of repair remains a point of contention. Several reports immediate repair is recommended for injured mid-urethra and/or bladder neck, as well as concomitant vaginal laceration, as a ruptured female urethra can induce full obliteration due to tissue inflammation and extensive scarring [11,12].

On the other hand, some reports indicate that stage repair may be the best alternative since the patient's situation is occasionally unstable, and cystostomy construction allows pelvic hematoma reabsorption and tissue inflammation decrease [13,14].

The correct fistula identification is the most crucial step in their management. Outside the emergency context, the workup includes pelvic examination with speculum and cystoscopy. In some cases, a fistula tract might be seen during clinical examination or by cystoscopy, although VVF can be very difficult to diagnose. When imaging modalities are not available, a “double dye test” might be helpful to better understand the fistula location. Preoperative understanding is of paramount importance in order to understand the number of fistulae (“hidden fistula”); their size, location, and distance from the ureteral orifices; as well as possible fistula branching. A CT scan with a cystogram can assist identify the specific location of the fistula. Magnetic resonance imaging (MRI) typically shows wall enhancement in active or healing VVFs. Healing VVFs may also include central granulation tissue. Factors influencing the success rate of VVF repair include size, location, prior fistula repair, clinical experience and skills of the surgeon, peri-fistula fibrosis that depends on the etiology and clinical course of VVF, and the quality of surrounding tissue such as peritoneum or sigmoidal epiploic appendices. Vesicovaginal fistulas can be treated using multiple ways, including conservative therapy, which has an 20% success rate [15]. Nonoperative treatment provides poor results, leading to surgery as the primary treatment option.

Vesicovaginal fistulas can be repaired by vaginal, abdominal, or laparoscopic/robotic techniques. Minimally invasive procedures, such as laparoscopic and robotic approaches, are increasingly used to improve visibility and reduce morbidity in open abdominal repair [16].

Bora et al. reported a 93% success rate in a cohort of 30 patients who underwent robotic assisted VVF repair using omental, sigmoid epiploic, or peritoneal tissue interposition over an average follow-up of 38 weeks [17]. The route depends on both the fistula's characteristics and the surgeon's experience. Traditional VVF repair methods include transabdominal for supratrigonal VVF and transvaginal for low lying fistulae [18]. While supra-trigonal fistulas can be repaired using laparoscopic technique, infratrigonal fistulas typically require transvaginal treatment due to their position [15,19].