Fistulas in Malignant Gynecologic Disease: Etiology, Imaging, and Management

Abstract

A fistula that occurs in association with a malignancy of the female reproductive tract may be caused by a primary or recurrent tumor or may be a complication of surgery or radiation therapy. Identification of the cause, complexity, and location of a fistula is essential for optimal management planning. Radiologic imaging, particularly with computed tomography and magnetic resonance techniques, is invaluable for the assessment of gynecologic fistulas and may help direct the clinician toward the most appropriate management pathway. The modality and technique selected for the initial imaging evaluation depend largely on the clinical history and manifestations. However, imaging with a combination of techniques often is required for accurate diagnosis and effective treatment planning. Radiologists should be familiar with suggestive clinical signs and symptoms as well as with the characteristic appearances of rectovaginal, vesicovaginal, ureterovaginal, enterovesical, enterocutaneous, and other pelvic fistulas at multimodality imaging.

Youssef's Syndrome - a complication of corrective surgery for mullerian anomaly

“…12 MRI is the investigation of first choice in diagnosing VUF. 13 Treatment of VUF includes expectant, medical and surgical management. Expectant management, i.e., wait and watch has also proven successful as in some cases; it can cause spontaneous closure of fistula.…”

Vesicouterine fistula presenting with urinary incontinence 30 years after primary Cesarean: Case report and review of the literature

“…11 MRI has now become the first choice in the investigation of fistulas. 12,13 Treatment methods include expectant management with long-term bladder catheterization, medical treatment, and surgery. Spontaneous closure of vesicouterine fistula has been reported.…”

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

“…Fisteln nach Bestrahlung finden sich in einigen Falldarstellungen [7,57,194]. Zu unterscheiden ist hier zwischen der Risikoerhöhung für die Entstehung von postoperativen rektovaginalen Fisteln am vorbestrahlten Rektum und spontan aufgetretenen Fisteln unter der Bestrahlung durch Tumorwachstum oder lokale radiogene Schädigung der Vaginal-und Rektumwand.…”

“…In einer Über-sichtsarbeit aus dem Jahr 2009 [194] werden die verschiedenen Fisteln bei gynä-kologischen Malignomen vorgestellt. Der Schwerpunkt liegt dabei auf vesikovaginalen und enterovaginalen Fisteln.…”