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Urogenital Imaging

Fistula, enterovesical

an abnormal communication between the bowel and the bladder. Enterovesical fistulas are relatively common, accounting for 1 in every 3,000 surgical admissions. These fistulas are more common in men, probably because the uterus acts as a partial barrier between the intestines and the bladder. Colovesical fistulas account for most enterovesical fistulas, and diverticular disease accounts for about 60% of colovesical fistulas. Other causes of enterovesical fistula include colon cancer (see carcinoma colorectal), Crohns disease, radiation enteritis (see enteritis radiation induced), trauma, bladder cancer, appendicitis, gynaecologic tumours, tuberculosis, and actinomycosis. Clinically, patients present with symptoms of bladder irritability. The classical symptoms of pneumaturia and faecaluria are not always present.

Intravenous urography (IVU) is not usually helpful in establishing a diagnosis of enterovesical fistula, though occasionally air in the bladder, an air fluid level in the bladder, or extravesical contrast in the bowel may suggest the diagnosis. Cystography is more accurate than IVU (Fig.1) but may fail to demonstrate the fistula in many cases. CT is the most accurate of all imaging tests. Scans must be performed without oral contrast. Scans are done after filling the bladder with contrast, and are repeated after voiding. The typical CT findings in enterovesical fistula are air in the bladder, focal bladder wall and adjacent bowel wall thickening, and extravesical soft tissue mass (which may or may not contain air or extraluminal contrast medium). Treatment is surgical.

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Fig.1

Lateral radiography taken during a cystogram showing contrast entering the rectum through a vesicoenteric fistula (arrow).
Fistula, enterovesical, Fig.1