Presentation
Prior hysterectomy and bilateral salpingo-oophorectomy. Newly diagnosed rectal tumor.
Patient Data
Status post hysterectomy.
A 5.6 cm length bulky tumor commencing 11 cm from the anal verge, adherent to the posterior aspect of the bladder is noted. Communication between the lumen of the upper rectum and bladder with moderate volume of air in the dependent position within the urinary bladder.
No bowel obstruction.
Solid organs of the upper abdomen normal.
No significant para-aortic or pelvic lymphadenopathy.
Large midline hernia containing transverse colon and small bowel.
No focal bone lesion.
CT for alternative indications following a defunctioning colostomy. CT cystogram performed.
Contrast instilled via a urinary catheter.
Contrast fills the rectum at the site of the tumor, with a fistulous tract into the posterior wall of the bladder.
The urinary bladder is full of contrast.
Case Discussion
Appearances in keeping with a T4 high rectal tumor with associated rectovesical fistula.
The patient proceeded to a defunctioning colostomy.
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