In 13 enemas performed by Giordano et al [36], the overall sensitivity was 7.7% for all fistula and 9% for those that involved the colon only. In a previous series of sigmoid vaginal fistulae, contrast enema detected the fistulae in 34% of cases [37]. For fistula to the urinary tract, Amendola et al compared contrast enema and cystography, which showed 50% and 30% of fistula, respectively, in 28 patients with surgically proven colovesicular fistula [38]. Fluoroscopy Cystography The data on diagnosis of rectovesicular fistula by cystography is limited to small series in older medical literature. In series of 30 patients with enterovesicular fistula, Hsieh et al [39] reported 90% were detected by cystography and 75% by contrast enema. Fluoroscopy Vaginography Fluoroscopic vaginography is performed after obtaining anterolateral and lateral scout radiographs or spot films. A large-gauge Foley catheter, such as a 26-guage with a 30-mL balloon, is placed in the vaginal lumen. The balloon is inflated to prevent the spillage of contrast material out of the vagina. Water-soluble contrast is injected under fluoroscopic guidance, and spot radiographs are obtained in the anteroposterior, right and left, oblique, and lateral views. Water-soluble contrast is preferred over barium because the endometrial cavity may fill in normal patients, and contrast may thus spill into the peritoneal cavity. Vaginography may also be performed with CT [40]. An unenhanced scan is obtained prior to vaginal opacification. The vagina is opacified in the same manner as in Anorectal Disease fluoroscopy; however, the water-soluble contrast is diluted with sterile water or normal saline (1/10, V/V) [40]. A second CT is obtained after vaginal filling. It may be acquired with or without IV contrast, depending upon the clinical indication. Giordano et al [36] reported a sensitivity of 79% and PPV of 100% for fluoroscopic vaginography for identification of fistulous tracts in 27 patients with suspected fistulae.
Anorectal Disease. In 13 enemas performed by Giordano et al [36], the overall sensitivity was 7.7% for all fistula and 9% for those that involved the colon only. In a previous series of sigmoid vaginal fistulae, contrast enema detected the fistulae in 34% of cases [37]. For fistula to the urinary tract, Amendola et al compared contrast enema and cystography, which showed 50% and 30% of fistula, respectively, in 28 patients with surgically proven colovesicular fistula [38]. Fluoroscopy Cystography The data on diagnosis of rectovesicular fistula by cystography is limited to small series in older medical literature. In series of 30 patients with enterovesicular fistula, Hsieh et al [39] reported 90% were detected by cystography and 75% by contrast enema. Fluoroscopy Vaginography Fluoroscopic vaginography is performed after obtaining anterolateral and lateral scout radiographs or spot films. A large-gauge Foley catheter, such as a 26-guage with a 30-mL balloon, is placed in the vaginal lumen. The balloon is inflated to prevent the spillage of contrast material out of the vagina. Water-soluble contrast is injected under fluoroscopic guidance, and spot radiographs are obtained in the anteroposterior, right and left, oblique, and lateral views. Water-soluble contrast is preferred over barium because the endometrial cavity may fill in normal patients, and contrast may thus spill into the peritoneal cavity. Vaginography may also be performed with CT [40]. An unenhanced scan is obtained prior to vaginal opacification. The vagina is opacified in the same manner as in Anorectal Disease fluoroscopy; however, the water-soluble contrast is diluted with sterile water or normal saline (1/10, V/V) [40]. A second CT is obtained after vaginal filling. It may be acquired with or without IV contrast, depending upon the clinical indication. Giordano et al [36] reported a sensitivity of 79% and PPV of 100% for fluoroscopic vaginography for identification of fistulous tracts in 27 patients with suspected fistulae.