Diuretic renography findings in enterovesical fistula

Large Bladder Stone Detected on Renal Scintigraphy

ABSTRACT

A 39-year-old woman with hydronephrosis underwent 99mTc-DTPA renal dynamic scintigraphy to evaluate renal function. The images revealed a central photopenic region in the urinary bladder. SPECT/CT images suggested the abnormal tracer distribution corresponding to a large urinary bladder stone.

Ureteroenteric Fistula Revealed by 99mTc-DTPA Renal Scan

A 55-year-old woman with a history of cervical carcinoma, status post hysterectomy and radiation therapy 8 years prior, presented worsening back pain for 9 months. The patient underwent a Tc-DTPA renal scan, which showed that a vertically linear tracer distribution was seen alongside the right ureter. Ureteroenteric fistula was confirmed and repaired by surgery.

Incidentally detected sigmoidovesical fistula in a case of rectosigmoid cancer detected on FDG PET-CT

Enterovesical fistulas are complications of advanced pelvic malignancies, repeated diverticulitis, and rare conditions like Crohn disease. They are difficult to demonstrate on conventional imaging and often are the source of recurrent urinary tract infections. An interesting case of sigmoidovesical fistula secondary to advanced rectosigmoid cancer is described in this case report.

Enterovesical fistulae: aetiology, imaging, and management

Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

Incidental detection of a vesicocolonic fistula on renal scintigraphy with SPECT/CT

Urinary-enteric fistula is a rare cause of recurrent urinary tract infection (UTI). Therefore, delayed/incidental diagnosis is the rule. The authors present an image of a vesicocolonic fistula incidentally detected during SPECT/CT renal scintigraphy with 99mTc-DTPA in a female patient with recurrent UTI. The diagnosis was subsequently confirmed by cystoscopy and surgery.

Enterovesical fistulas: diagnosis and management

Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder. It represents a rare complication of inflammatory or neoplastic disease, and traumatic or iatrogenic injuries. The most common aetiologies are diverticular disease and colorectal carcinoma. Over 75% of affected patients describe pathognomonic features of pneumaturia, faecaluria and recurrent urinary tract infections. The diagnosis of EVF can be challenging, and frequently patients are monitored for months before the condition is recognised and treated effectively. Diagnostic tools include laboratory tests, imaging studies and endoscopic procedures. Although conservative management can be attempted in selected patients, in most cases, the treatment is mainly based on surgical interventions. Recently, the laparoscopic approach to EVF has been shown to be safe and effective. Although it is a rare condition in a general surgery setting, EVF is a challenging condition leading to high morbidity and mortality rates.

[Utility of diuretic renography in the detection of an enteroureteral fistula]

After a 2-year-old male with left impairment underwent surgery for a left vesicoureteral stenosis, his renal function was followed up by means of dynamic renal scintigraphy with 99mTc-DTPA. Incidental radiotracer accumulation was observed in left hemiabdomen tracing the descending and sigmoid colon. A vesico-colonic fistula was suspected. However, ultrasonography and cystography studies showed no presence of a vesico-enteric fistula. Because the patient persisted without symptoms, an expectant approach was adopted. One year later, he began to suffer watery diarrhoea episodes. 99mTc-DTPA renography was again performed to re-evaluated renal function and explore presence of urinary-enteric fistula. Diuretic renography demonstrated the presence of a vesical leak to sigmoid gut, which was confirmed by recovery of fecal matter from the patient. Both isotopic renograms evidenced the presence of uretero-sigmoid fistula, an uncommon postsurgical that was not detected by cystography, ultrasonography or RMN. The patient subsequently underwent surgery for fistula repair.

Diagnostic lessons learnt from a series of enterovesical fistulae

OBJECTIVE

An enterovesical fistula (EVF) is an uncommon condition requiring careful and sometimes extensive preoperative investigation. Our experience over a 10-year period has been reviewed with emphasis on the diagnostic investigations performed.

PATIENTS AND METHOD

Forty-two patients (30 male) have been studied. Presenting symptoms, diagnostic investigations, and subsequent treatment have been reviewed.

RESULTS

The site of the fistulae were; 37 colonic, 2 rectal, and 3 ileal. The commonest presenting symptoms were; pneumaturia 75%, faecaluria 63% and urinary tract infections 57%. The positivity rate of the investigations performed were; cystoscopy 89%, urine cytology 86%, barium enema 65%, computerized tomography (CT) scanning 55%, IVP 35%, and cystography 27.5%. The causes of the fistula were; diverticular disease 71%, carcinoma 20%, Crohn's disease 7%, and radiotherapy 2%.

CONCLUSIONS

We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.