Rectovesical fistula

Case contributed by Dr Ian Bickle

Presentation

Prior hysterectomy and BSO. Newly diagnosed rectal tumour.

Patient Data

Age: 55 years
Gender: Female
CT

CT abdomen

Hysterectomy.

5.6 cm length bulky tumor commencing 11 cm from the anal verge, adherent to the posterior aspect of the bladder. 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

CT performed for alternative indications following a defunctioning colostomy. CT cystogram performed.

Contrast inserted via 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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Case information

rID: 48641
Published: 29th Oct 2016
Last edited: 20th Sep 2018
System: Gynaecology
Inclusion in quiz mode: Included

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