Anovaginal fistula (MRI enema)

Case contributed by Vikas Shah
Diagnosis almost certain

Presentation

Rectovaginal fistula after childbirth. Assess for healing.

Patient Data

Age: 30 years
Gender: Female

MRI enema

mri

Volume T2 acquisitions, pre and post introduction of 120 ml of sterile ultrasound gel per anally.

Gel is seen to enter an anterior track (from the 12 o'clock position) between the upper anal canal and the posterior vagina, indicating a persistent anovaginal fistula. This track is not appreciated on the pre-gel sequence.

Case Discussion

An MRI enema protocol utilizes the soft tissue resolution of MRI to delineate vaginal and anorectal anatomy, with the luminal gel insertion providing further data regarding the possibility of a fistula track. Multiplanar reformats of the volume T2 sequences aid in image analysis and reporting. The study can be acquired in 20 minutes and avoids the need for radiation from fluoroscopy or CT, of greater importance in younger patients undergoing investigation for obstetric anorectovaginal fistula.

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