Post-radiation vesicocolonic fistula demonstrated on bone scintigraphy

Abstract

An 81-year-old man with prostate carcinoma and known lung and bone metastases underwent prostatectomy followed by radiotherapy 8 years previously. Whole-body bone scintigraphy demonstrated unexpected diffuse colonic uptake (a). The patient had suffered from recurrent urinary tract infection, haematuria, faecaluria and recurrent diarrhoea during the previous several months. Therefore, cystography was performed that revealed a fistulous communication between the bladder and the caecum (b). Most likely the fistula is related to the radiation therapy the patient had received in years past. Its presence explains the radionuclide flow from the bladder to the intestine as well as the low radionuclide concentration in the urinary bladder. A urinary fistula should always be considered when a communication between the gastrointestinal tract and the genitourinary system is detected or when the radionuclide is demonstrated in the surrounding tissue of the bladder. Most fistulas occur as a complication of abdominal surgery or trauma. A spontaneous fistula is usually the result of intra-abdominal inflammation or infection and is associated with higher mortality and morbidity rates as well as increased health care costs for diagnosis and treatment. [1–4]. It is of utmost importance to correlate this prominent imaging finding with patient history. References