Rectovaginal fistula

Case contributed by Dr Ian Bickle

Presentation

Patient with clinical concerns over a colovesical fistula.

Patient Data

Age: 65 years
Gender: Female

Linear channel of contrast anterior to the rectum, extending towards the perineum in keeping with a contrast filled vagina. 

Case Discussion

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.

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