Presentation
Rectovaginal fistula after childbirth. Defunctioning colostomy. Assess for fistula healing.
Patient Data
Standard and volume T2 acquisitions after introduction of 120 ml of sterile ultrasound gel per anally.
Gel is seen to enter an anterior track (12 o'clock position) between the low rectum (just above the anorectal junction) and the posterior vagina, with gel within the lumen of the vagina, indicating a rectovaginal fistula.
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.