Rectovaginal fistula

Case contributed by Ian Bickle
Diagnosis certain


Known rectal malignancy. Defaulted and refused treatment. Returns several months later.

Patient Data

Age: 55 years
Gender: Female

Circumferential thickening of the distal rectum, with extra-serosal extension (best observed at 8 and 12 o'clock).

Extensive mesorectal lymphadenopathy and large metastatic mass.

Annotated image

Annotations indicating the fistulous tract (arrows) between the vagina (V) and the rectum (R), in which is a tumor.

Case Discussion

Colovaginal fistula are most commonly observed in the context of advanced colorectal malignancy or severe diverticular disease.

The fistula may be identified on CT, MRI or fluoroscopy.

A tract is evident with air communication from the rectum into the vagina.

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