S2197 A Case of Recurrent Urinary Tract Infections Secondary to Vaginovesicular and Vaginorectal Fistula

Abstract

Introduction: Enterovesical fistulas are a rare disease with an annular incidence of 0.5 per 100,000. The most common clinical presentations of enterovesicular fistulas are urinary tract infection. We present a rare case of a chemotherapy-induced vagionvesicular and vagionrectal fistula. Case Description/Methods: Our patient is a 78-year-old female with a history of squamous cell anal cancer status post chemotherapy, cervical cancer status post total abdominal hysterectomy and recurrent E. coli urinary tract infections who presented with 3 weeks of painless, bright red blood per rectum without associated abdominal pain, nausea or vomiting. The patient’s last colonoscopy was 6 years prior which had revealed a hyperplastic polyp. In the ED, she was found to have a hemoglobin of 7.2 with an MCV of 92.8. An abdominal CT scan revealed an ill-defining hyperattenuating material with single focus of gas between urinary bladder and rectum with concern for a possible colovesicular fistula. A CT Cystogram was unable to be obtained as the patient denied a foley placement. A CT abdomen/pelvis with oral and rectal contrast revealed nodular hyperdense material anterior to the rectum and along the posterior margin of the presumed urinary bladder confirming a colovesicular fistula. The patient was transferred to a tertiary care center for colorectal surgery (Figure). Discussion: A radiation-induced fistula is a chronic and serious condition with a significant impact on quality of life. To our knowledge, this is the first case that reveals both a vaginovesicular and vaginorectal fistula secondary to chemotherapy treatement of squamous cell anal cancer.Figure 1.: Sagittal image of the right paramedian aspect of the pelvis shows 2 prominent locules of air within the vaginal vault and the decompressed urinary bladder. There are subtle curvilinear tracts of air extending from these locules.