Magnetic resonance imaging and hysteroscopy to diagnose colo‐uterine fistula: A rare complication of diverticulitis

Abstract

Colo-uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non-invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78-year-old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non-invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.

Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon

“…However, detection of the fistula tract or differentiation of complicated diverticulitis from colon cancer may be limited in CT findings [6]. Therefore, many imaging modalities have been suggested for the diagnosis of a colouterine fistula [8, 9]. Although colonic lesions such as diverticulosis might be identified by using colonoscopy or a barium enema, these procedures are not helpful in the diagnosis of a colouterine fistula.…”

“…However, in some cases, the colonic fistula opening may be detected, as in the present case. Kassab et al [8] reported that magnetic resonance imaging (MRI) was a versatile, noninvasive, more sophisticated, detailed, and accurate diagnostic tool compared to CT scanning. In their report, MRI was used to identify fistulae, and T1-weighted images delineated the extension of the fistula relative to the adjacent organ and showed inflammatory changes in fat planes.…”

Diverticulitis: a comprehensive review with usual and unusual complications

“…CT may demonstrate air bubbles within the uterine cavity, which is a highly specific finding, if detected. MRI and sonohysterography were also reported to be helpful in detecting colouterine fistula [32, 33]. …”

Sigmoidouterine Fistula: Anal Menstruation as a Rare Presentation

“…Beattie et al (2005) are of the opinion that multidetector computed tomography (MDCT) provides better visualisation of fistula, but it is associated with still greater radiation. Kassab et al (2008) have found MRI to be a more versatile, sophisticated and accurate diagnostic tool in showing the fistula. Huetter et al (1992) suggested that Charcoal Challenge Test could prove to be a non-invasive useful modality for the diagnosis of such an entity, but was not done by us as it cannot identify the exact site of the fistula and the tract.…”