Stage 4 endometrial carcinoma. Clinically rectovaginal fistula. CT Abdomen one month prior - abnormal soft tissue in the pelvis.
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Contrast administered per rectum.
Contrast enters the upper vagina via a fistulous tract from the mid rectum at the level of the lower sacral segments.
Contrast on the 'inko pad' on the patient's bed.
Rectovaginal fistulas are usually best illustrated on fluroscopic studies.
Advanced gynaecological and rectal cancers account for the majority of malignant causes, with complicated diverticular disease the single most common overall cause.