Value of direct radionuclide cystography in diagnosing vesico-peritoneal fistulae

Piotr Szumowski, Szumowski P, Abdelrazek S, Saeid Abdelrazek, Małgorzata Mojsak, Mojsak M, Robert Kozłowski, Kozłowski R, Monika Sykała, Sykała M, Jurgilewicz D, Dorota Jurgilewicz, Janusz Myśliwiec, Myśliwiec J
Nuclear medicine review. Central & Eastern Europe · 2017 · vol. 20(2) , pp. 105–106 · doi:10.5603/NMR.2017.0018 · PMID:30900239
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Direct radionuclide cystography with SPECT/CT successfully diagnosed a vesico-peritoneal fistula in a patient initially evaluated for endometriosis, leading to effective catheter treatment and symptom resolution.

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This case report describes a 36-year-old woman whose pelvic pain persisted after laparoscopic myomectomy, prompting an investigation to differentiate between a vesico-uterine fistula and endometriosis. Standard diagnostic imaging including cystography, CT, and MRI failed to identify the pathology, and laparoscopy with biopsy yielded negative results for endometriosis but revealed inflammatory lesions suggestive of a fistula. Direct radionuclide cystography using SPECT/CT successfully localized a vesico-peritoneal fistula, which was subsequently managed with bladder catheterization leading to symptom resolution and confirmed healing on follow-up imaging. Relevance to endometriosis: The paper is relevant because endometriosis was explicitly considered as a differential diagnosis during the clinical workup, although the final confirmed condition was a vesico-peritoneal fistula resulting from prior surgery.

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Abstract

A 36-year-old female patient underwent a laparoscopic surgery to remove a uterine fibroid. The procedure failed to relieve the pelvic pain, although its nature changed. After a period of observation, the patient was re-admitted to hospital on suspicion of a vesico-uterine fistula to be differentiated with endometriosis. Diagnostic investigations - cystography, cystoscopy, computed tomography and magnetic resonance - did not reveal a fistula. Laparoscopy was performed, with a possible biopsy in order to eliminate endometriosis. The result was negative, but chronic progressive reactive/inflammatory lesions were noticed, possibly indicating the presence of a vesico-peritoneal fistula. Therefore, a direct radionuclide cystography was performed. The scintigraphic images single-photon emission computed tomography (SPECT/CT) showed a radioactive spot, indicative of a vesico-peritoneal fistula. The fistula was treated for three months by catheterisation of the urinary bladder. The follow-up SPECT-CT did not reveal any urine leakage from the bladder. The clinical symptoms disappeared as well.
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Abstract

A 36-year-old female patient underwent a laparoscopic surgery to remove a uterine fibroid. The procedure failed to relieve the pelvic pain, although its nature changed. After a period of observation, the patient was re-admitted to hospital on suspicion of a vesico-uterine fistula to be differentiated with endometriosis. Diagnostic investigations — cystography, cystoscopy, computed tomography and magnetic resonance — did not reveal a fistula. Laparoscopy was performed, with a possible biopsy in order to eliminate endometriosis. The result was negative, but chronic progressive reactive/inflammatory lesions were noticed, possibly indicating the presence of a vesico-peritoneal fistula. Therefore, a direct radionuclide cystography was performed. The scintigraphic images single-photon emission computed tomography (SPECT/CT) showed a radioactive spot, indicative of a vesico-peritoneal fistula. The fistula was treated for three months by catheterisation of the urinary bladder. The follow-up SPECT-CT did not reveal any urine leakage from the bladder. The clinical symptoms disappeared as well.

Keywords

radionuclide cystographysingle-photon emission computed tomographyvesico-peritoneal fistule

References

- Fettich J, Colarinha P, Fischer S, et al. Guidelines for direct radionuclide cystography in children. Eur J Nucl Med Mol Imaging. 2003; 30(5): B39–B44. - Yu NC, Raman SS, Patel M, et al. Fistulas of the genitourinary tract: a radiologic review. Radiographics. 2004; 24(5): 1331–1352. - Tang YZ, Booth TC, Swallow D, et al. Imaging features of colovesical fistulae on MRI. Br J Radiol. 2012; 85(1018): 1371–1375. - Andersson M, Johansson L, Minarik D, et al. Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors. EJNMMI Phys. 2014; 1(1): 9.

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