Rectovesical fistula and rectal anastomotic leak

Case contributed by Dr Ian Bickle

Presentation

Rectal cancer with bladder invasion. Inpatient following resection and partial cystectomy. Suprapubic and uretheral catheters in situ.

Patient Data

Age: 70
Gender: Male

Cystogram

Bladder filled via suprapubic catheter.

Contrast enters the rectum. However, appearance not entirely fitting with this alone.

CT

The radiologist decides to clarify anatomical details with CT

CT Cystogram (both catheters clamped)

Three smaller tracts from the posterior wall of the residual bladder with contrast in the rectum.

Large volume of pre-sacral contrast and a large gap with contrast contiguous with the rectum at 9 O'clock at the level of the anastomosis.

Annotated image

The leak from the anastomatic break-down (red arrow) at 9 O'clock from the rectum into the para-rectal and pre-sacral spaces.

Case Discussion

This patient has a T4 rectal tumour with invasion of the posterior bladder wall at surgery.  A partial cystectomy was performed.

In the early post-operative stage the following developed:

1.  A rectovesical fistula

2.  A rectal anastomotic leak with pre-sacral collection

Contrast was only injected via the suprapubic catheter so after contrast entered the rectum from the bladder through the fistula, it then leaked via the anastomotic breakdown into the pre-sacral space.

The patient returned to theatre.  Dense adhesions meant a end colostomy had to be performed.

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Case information

rID: 52912
Case created: 26th Apr 2017
Last edited: 30th May 2017
Inclusion in quiz mode: Included

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