Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication

Abstract

Colovesical fistula is an abnormal connection between the enteric and urinary systems, usually sigmoid colon, caused by various conditions. One cause of colovesical fistula is iatrogenic injury, such as induced by inguinal hernia surgery. We present a case of colovesical fistula. A 57-year-old male was admitted to a local hospital with complaints of dysuria and pneumaturia. He had a past history of total extraperitoneal laparoscopic inguinal hernia repair operation 7 years previously for bilateral inguinal hernia. The case was assessed with radiologic and scintigraphic techniques. Radiologic techniques (plain abdominal radiography, intravenous pyelogram, ultrasound examination, double-contrast barium enema, CT, MRI) were inadequate to determine the colovesical fistula. The colovesical fistula was visualized with direct radionuclide voiding cystography as an alternative scintigraphic method.

Enterovesical fistulas: diagnosis and management

“…Iatrogenic fistulae are induced by surgical procedures, including augmentation cystoplasty [26], prostatectomy, rectal resections and laparoscopic inguinal hernia repair [3,27], or endoscopic procedures as colorectal stenting for malignant obstruction [28]. Iatrogenic EVF can represent a rare complication of indwelling urethral catheterisation, generally in patients with previous pelvic radiotherapy [29].…”

A Case of Enterocutaneous Fistula Diagnosed with Tc-99m DTPA Fistulography Using Hybrid SPECT/CT

“…There was a report in which direct radioisotope cystography detected colovesical fistula and provided further information on fistula [5]. In another report, Tc-99m sulfur colloid SPECT/CT found peritoneal fistula successfully after kidney transplantation [12].…”

“…Tamam et al [5] reported cystography imaging in colovesical fistula with Tc-99m DTPA and provided dynamic subsequent images. We also chose Tc99m DTPA, as it is a water-soluble, non-irritatant, and particularly, easily absorbed radiopharmaceutical in case of unexpected leakage through the fistula.…”

“…A SPECT/CT was performed to evaluate fistula tract, with reference to previous studies in colovesical fistula [5] or ureterovaginal fistula [6]. Tc-99m DTPA (37 MBq) was administered aseptically into the putative fistula tract via an inserted catheter, and 30 min after injection, planar and indicated the catheter insertion site where the fistula opening existed; the red arrow indicats the urine radioactivity from the drainage bag connected to the ileal conduit.…”

Enterovesikale Fisteln

“…Iatrogene Fisteln werden durch chirurgische Eingriffe verursacht, z. B. nach Augmentationszystoplastik [26], Prostatektomie, rektalen Resektionen sowie laparoskopischen inguinalen Herniotomien [3,27] oder endoskopischen Eingriffen wie kolorektalen Stentimplantationen wegen maligner Obstruktion [28]. Die iatrogene EVF kann eine seltene Komplikation von urethralen Dauerkathetern sein, im Allgemeinen bei Patienten mit früherer Strahlenbehandlung des Beckens [29].…”