Uretero-Iliac Artery Fistula: Intraoperative Diagnosis of a Rare but Fatal Cause of Hematuria.

Uretero-iliac artery fistula (UIAF) is a rare but often fatal type of fistula. We present the case of a 58-year-old woman who presented with recurrent hematuria. During her admission, she underwent a routine ureteric stent exchange. During the procedure, she developed sudden hemorrhagic shock during guidewire insertion, and a diagnosis of UIAF was suspected. The patient required resuscitation and urgent right common iliac artery stent placement by interventional radiology (IR) following discussion between vascular surgeons and the IR team. She was admitted to the intensive therapy unit following the IR intervention, where she recovered well without complications. She was discharged home three days later with outpatient vascular and urology follow-up. UIAF is a rare but important differential diagnosis of hematuria. A high index of clinical suspicion is important to facilitate its diagnosis. Eliciting the patient's past medical history and risk factors is of paramount importance in raising suspicion for UIAF.