Presentation
Rectal malignancy. Concerns of post operative rectovesical fistula.
Patient Data
Fistulous tract from the posterior bladder to the upper rectum.
Case Discussion
Classic fluoroscopic appearances of a rectovesical fistula.
Many consider fluoroscopic studies from an era of 'dinosaur radiology'. There are several indications where it remains the 'bees-knees', one being the assessment of fistula and leaks.
It's truly dynamic, unlike a CT with contrast squirted into a tube before any pictures are taken.
Two other practical tips:
- with the bladder always screen initially in the lateral position. Small leaks, the origins of them or fistula may be missed by the covering contrast filled bladder.
- fill the bladder until the patient's toes curl. This ensures the bladder is sufficiently distended and pressurised to ensure a false negative study doesn't occur.
The patient will thank you later for getting it right rather than missing it by not distending the bladder well enough.