Presentation
Total hysterectomy and bilateral salpingo-oopherectomy for endometrial small cell cancer. Also being treated with chemotherapy.
Patient Data
The vaginal stump is distended with fluid with contrast opacification on the delayed scan. Opacified tract is seen communicating between the supravesical portion of the distal right ureter and the vaginal stump.
Case Discussion
The filling of the vaginal stump with contrast and the contrast-enhanced tract between the distal segment of the right ureter and vaginal stump are in keeping with right ureterovaginal fistula. Hysterectomy is the commonest predisposing factor for ureterovaginal and vesicovaginal fistulas. The fistula tract may be seen as opacified linear connection connecting the ureter to the vaginal stump on delayed contrast enhanced CT images.
Vesicovaginal fistula also occurs in approximately 10% of cases, which couldn't be completely excluded in this case as the urinary bladder is opacified in the delayed phase and the vagina is opacified through the ureterovaginal fistula and so separate retrograde contrast study (CT cystogram) could be performed to exclude concomitant vesicovaginal fistula.