Learning objectives
1. Define fistulas and present their causes.
2. Identify-demonstrate CT and MRI findings in order to avoid missing the diagnosis.
Background
Fistulas are abnormal connections between organs or vessels either directly or often via an abscess cavity.
They are usually named based on the participating anatomic structures.
They can be idiopathic- or occur as a result of several causes either acquired,
which is the focus of our study or congenital.
Acquired causes include iatrogenic (post-surgical,
percutaneous procedures etc),
abdominal malignancies (colon cancer etc),
infections (cholecystitis,
pancreatitis,
appendicitis,
pyelonephritis,
diverticulitis etc),
radiation therapy,
foreign bodies,
trauma and any significant inflammatory process (Crohn’s disease).
In some instances,
the...
Findings and procedure details
Categorization of abdominal fistulas and cross sectional imaging findings
Alimentary fistulas:
Gut-gut fistulas (entero-enteric,
colo-enteric,
colo-duodenal,
colo-gastric): Oral contrast administration when performing CT may help depict the tract.
MRI images may also aid in diagnosing these connections.
The “star- sign” or “stellate pattern” is present in 26.3% ofenteroentericfistulas.
Gut-skin/ gut-articular fistulas (entero-cutaneous,
gastro-cutaneous,
colo-cutaneous,
perianal fistulas and entero-articular): As previously mentioned CT and MR imaging help detect the fistula tract as well as collections-abscesses because of bowel’s content into the skin.
MRI is the modality...
Conclusion
MRI and CT imaging in combination with multiplanar visualization have a pivotal role in detecting fistulas,
as well as recognizing the etiology which is crucial for deciding the appropriate treatment.
Personal information
Dr Vasiliki Mellou
Radiology Department,
“Evangelismos” General Hospital of Athens - Athens/GR
email:
[email protected]
References
Thomas HA.
Radiologic investigation and treatment of gastrointestinal fistulas.
Surg.
Clin.
North Am.
1996;76 (5): 1081-94.
- Pubmed citation
Pickhardt PJ,
Bhalla S,
Balfe DM.
Acquired gastrointestinal fistulas: classification,
etiologies,
and imaging evaluation.
Radiology.
2002;224 (1): 9-23.
doi:10.1148/radiol.2241011185 - Pubmed citation
Semelka RC,
Hricak H,
Kim B et-al.
Pelvic fistulas: appearances on MR images.
Abdom Imaging.
22 (1): 91-5.
Abdom Imaging (link) - Pubmed citation
Hession PR,
Rawlinson J,
Hall JR et-al.
The clinical and radiological features of cholecystocolic fistulae.
Br J Radiol.
1996;69 (825):...