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 · doi:10.5603/NMR.2017.0018 · PMID:30900239
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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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