Magnetic resonance imaging (including magnetic resonance cholangiopancreatography) and fistulogram
may be useful for diagnosis but are usually not needed.
Patient was discharged and at subsequent hemodialysis the patient was found to have elevated venous pressures which prompted interrogation via a fistulogram
. The venogram study was done in June 2016 with findings of long segment tight CAS (Figure 2(a)) and two large aneurysms (Figure 2(b)).
Few centres including our own have shown improved visualisation of fistulous tracts and their relationship to the surrounding perianal structures using MR fistulogram
, a procedure involving injection of diluted gadolinium into the tract using an infant feeding tube.
Visualization of blood flow, as demonstrated by a fistulogram
, was an endpoint before leaving the procedure room.
The confirmatory diagnosis, however, is made via a fistulogram
(angiography) with and without manual compression.
Finally, a fistulogram
was performed and was conclusive for an enterocutaneous fistula (Figure 2).
was done which showed a communication of the track with the gut.
Moreover, lower back pain and pneumaturia are rare.[sup.3] In the absence of pneumaturia, the diagnosis is done radiologically either by barium enema, retrograde pyelogram, CT scan or fistulogram
.[sup.3] In our 2 cases, the pneumaturia was very evocative and the uro-CT was able to confirm the diagnosis.
It can be performed through percutaneous non-surgical procedures like Fistulogram
, Fistuloplasty, stenting and thrombolysis.
According to the fistulogram
, the right tract was continuous with the oropharyngeal area and the left punctum showed pooling of contrast material in the cervical area (figure 2).
Investigations are invariably non-specific, and the diagnosis is nearly always made radiologically through a barium enema, RGP, antegrade pyelography, CT scan or if there is cutaneous extension, fistulogram
. (2), (5) The mainstay of treatment for renocolic fistulas is open surgery, with the exception of postinstrumentation fistulas, which if very small, may be treated conservatively.
or MRI which can outline the track and the level of the internal opening.