Female with clinical concerns over a colovesical fistula.
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Linear channel of contrast anterior to the rectum, extending towards the perineum in keeping with a contrast filled vagina.
Water soluble contrast is administered via a rectal catheter. Although a fistula may be identified on CT, including with rectal contrast distilled on table, traditional fluroscopy remains the premier modality, offering dynamic assessment.
Contrast promptly fills the vagina, in keeping with a rectovaginal fisula - the commonest form of colovesical fistula.
The commonest causes are; diverticular disease, malignancy and following pelvic radiation. A diverticulum can be seen in this case.