Vesicocutaneous fistula presenting as a thigh abscess

An abscess of the thigh may be a sign of tracking intra-abdominal pathology, often from the gastrointestinal tract. Less frequently this can arise from the bladder, usually after a history of surgical intervention, radiotherapy or pelvic trauma. This case describes a patient with a history of bladder cancer who developed a bladder perforation communicating with the thigh which presented as an abscess. Incision and drainage was atypical with clear, odourless fluid drained. CT scan and retrograde cystogram confirmed bladder perforation and vesicocutaneous fistula. They later developed a rectal perforation secondary to the pelvic urinoma.