Recto-Vaginal Fistula – Hysterosalpingography
HSG
Recto-vaginal fistula is an abnormal communication between the rectum and the vagina, usually resulting from obstetric trauma, pelvic surgery, radiation, inflammatory bowel disease, or infection. On contrast studies and occasionally on hysterosalpingography (HSG), contrast introduced into the vagina or uterine cavity may pass into the rectum, confirming the fistulous tract.
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Findings: The uterine cavity may appear normal. Contrast outlines the vaginal canal and is seen entering the rectum through a defined fistulous tract.
Conclusion: Imaging findings are consistent with recto-vaginal fistula.
Patient Symptoms
Patients may present with passage of flatus or fecal matter through the vagina, recurrent vaginal or urinary infections, foul-smelling vaginal discharge, and pelvic discomfort.
Procedure (Hysterosalpingography)
HSG is performed cautiously in the early proliferative phase. Low-pressure contrast injection is essential to avoid further tissue damage.
Contrast Medium & Administration
A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 5–8 mL is injected slowly under fluoroscopic guidance.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Vaginal catheter or cannula
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Active pelvic infection is a contraindication. Excessive injection pressure should be avoided to prevent enlargement of the fistulous tract.
Related Conditions
Differential diagnoses include vesico-vaginal fistula, vesico-uterine fistula, uterine fistula, post-surgical vaginal defects, and inflammatory bowel disease-related fistulas. Correlation with clinical findings, endoscopy, CT, or MRI is recommended.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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