Vaginal fistula.
- is a significant management problem for patients because of the
malodorous vaginal discharge and fecal or urinary incontinence.
- Diverticulitis of the colon is the commonest cause.
- The thick-walled uterus and its broad ligament serve as an
anatomic barrier to the development of colovesical and colovaginal
fistulas. Thus, women who have undergone hysterectomy have a much
greater frequency of fistulas from diverticulitis.
- Other causes of vaginal fistulas include sigmoid or rectal cancer,
gynecologic malignancy, Crohn's disease, radiotherapy, trauma during
pelvic surgery, anastomotic leaks, and blunt pelvic trauma.
Vaginography.
- is superior to all other imaging modalities currently available in
its ability to demonstrate the presence and anatomy of high vaginal
fistulas.
- It has a sensitivity of 79-85% and positive predictive value of
100%.
- This is compared to barium enema with a sensitivity of 9-34% and
computed tomography with a reported accuracy of 60%.
- Vaginography has also been proven superior to small bowel barium
studies, charcoal challenge, tandem colovaginoscopy, flexible
vaginoscopy, and magnetic resonance imaging.
- In addition to detecting vaginal fistulas, vaginography has also
been used to identify colouterine fistulas and ectopic insertion of a
ureter into the vagina.
- For low vaginal fistulas caused by obstetrical trauma or other
perineal trauma, vaginography may be unsuitable because of the Foley
catheter balloon being inflated either above the fistula or at the
level of the fistula and occluding its orifice.
- Vaginography is easy to perform, relatively economical, and causes
little or no patient discomfort.
|
