Demonstration of rectosigmoid fistula dynamic scintigraphic peritoneography

Intraperitoneal installation of chemotherapy through a Mediport implanted subcutaneously in the abdominal wall is used currently for treatment of peritoneal metastases from ovarian, gastric and colonic carcinoma. There is a variable incidence of complications due to the procedure reported in the literature. The main predisposing factor for these complications is the inhomogeneous distribution of the chemotherapeutic drugs within the peritoneal cavity. We report an unusual case of a rectosigmoid fistula that developed 6 wk following the insertion of a Bardport subcutaneously in the abdominal wall for intraperitoneal therapy. The fistula was clearly demonstrated by dynamic scintigraphic peritoneography. This is a new modification of scintigraphic peritoneography as practiced routinely. We endorse the previous recommendation that scintigraphic peritoneography be performed before every intraperitoneal installation of a chemotherapeutic drug or radiopharmaceutical to ensure the homogeneous distribution of the drugs and to prevent complications.