CT evaluation of enterovaginal and vesicovaginal fistulas

Computed tomography of 25 cases of enterovaginal (19 cases) or vesicovaginal fistula (6 cases) were reviewed. Underlying causes of fistulization included gynecological malignancy and radiation therapy (14 of 25), inflammatory diseases of bowel (8 of 25), and miscellaneous conditions (3 of 25). A CT finding of contrast within the vagina provided definitive confirmation of the suspected diagnosis of vaginal fistula in 60% of patients (15 of 25), a detection rate superior to conventional examinations in our series. Other CT findings suggestive of vaginal fistulas included detection of air (20 of 25) and/or fluid (5 of 25) within the vagina. Computed tomographic findings associated with vaginal fistulas such as radiation changes, contiguous pelvic mass, or adherent thickened bowel gave clues to the underlying etiology of the fistula and provided important information regarding the extent of disease prior to attempted surgical repair.