a 31y/o woman presenting with fecaluriaand pneumaturia

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Maryam Sheikh

 

Case Section

Uroradiology & Genital Male Imaging

 

Patient's Information

Gender : Female
Age : 31

 

Clinical Summary

A 31y/o woman a case of rectal cancer presenting with fecaluria and pneumaturia after operation.

 

Imaging Findings

MRI T1W vibe with contrast and T1-tse-fat sat sequences in coronal,sagital views demonstrate: A fistula tract in the anteroinferior aspect of rectum,superior to anal verge,which comunicate with bladder by passing through the vagina. Tract wall enhancment shows that it's active. Pelvic wall muscle(obturator internus,externus and priformis m.) inflamation is seen.

 

Differential Diagnosis

Abdominal abscess,Penetrating abdominal trauma,Appendicitis,Inflammatory bowel disease,Diverticulitis

 

Final Diagnosis

Vesicovaginorectal fistula

 

Discussion (Related Text)

A fistula (a term derived from the Latin word for pipe) is an abnormal connection between 2 epithelialized surfaces that usually involves the gut and another hollow organ, such as the bladder, urethra, vagina, or other regions of the gastrointestinal (GI) tract. Fistulas may also form between the gut and the skin or between the gut and an abscess cavity. Rarely, fistulas arise between a vessel and the gut, resulting in profound GI bleeding, which is a surgical emergency.
Most GI fistulas (75-85%) occur as a complication of abdominal surgery. However, 15-25% of fistulas evolve spontaneously and are usually the result of intra-abdominal inflammation or infection.
The frequency of fistula formation has not decreased, because of advanced and complicated disease, complex surgical techniques, and an aging popPatients with rectovaginal and anovaginal fistulas may be asymptomatic and present with symptoms only when the bowel movements are more liquid. Possible symptoms include inadvertent passage of stool or gas, dyspareunia, and perineal pain.
While identification of the fistula is not always possible, CT scanning often reveals perifistular
inflammation. This provides additional information regarding the possible etiology of the fistula and the extraluminal involvement of disease.
Although magnetic resonance imaging (MRI) is reported as an imaging modality that can help identify and characterize enteric fistulas, motion artifact may limit its usefulness, and MRI is not considered a routine adjunctive study in the evaluation of patients with enteric fistulas. T1-weighted images provide information relative to the inflammation in fat planes and possible extension of the fistula relative to the surrounding visceral structures. T2-weighted images can demonstrate fluid collections along the fistula tract and inflammatory changes within the surrounding muscle.
Fistulography
Radiographic study with contrast medium (usually given at the site of fistula output) may be performed to help delineate the extent of the fistula and its communication with the underlying bowel.
Ultrasonography
Ultrasonography can be used in conjunction with physical examination to identify abscesses and fluid collections along the fistula tract.
Cystography and CT cystography
This procedure can help to evaluate for the presence of a possible enterovesical fistula.

 

References

Medescape.com

 

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