Fistulogram- Report template female

📝 CONTRAST MEDIA X-RAY TEMPLATES

📝 Barium Swallow

📝 Barium Meal

📝 BFT (Barium Follow Through)

📝 Barium Enema

📝 IVU / IVP

📝 MCU / VCUG

📝 RGP (Retrograde Pyelography)

📝 Angiography

📝 Venography

📝 HSG (Hysterosalpingography)

📝 Fistulogram-Male

📝 Fistulogram-Female

─── 🧾 Fistulogram - Female───

Templates

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COUNSELING DAY

📄 Normal Stady

BASED ON SITE OF INTERNAL OPENING

📄 Rectovaginal fistula – rectum → vagina

📄 Anovaginal fistula – anal canal → vagina

📄 Vesicovaginal fistula – bladder → vagina

📄 Ureterovaginal fistula – ureter → vagina

📄 Enterovaginal fistula – bowel → vagina

📄 Rectocutaneous fistula – rectum → skin

📄 Anocutaneous fistula – anal canal → skin

📄 Enterocutaneous fistula – small intestine → skin

📄 Perianal fistula – inter / trans / supra / extra-sphincteric

BASED ON TRACT PATTERN

📄 Single simple fistula

📄 Multiple fistulous tracts

📄 Branching / complex fistula

📄 Blind-ending sinus tract

BASED ON COMPLICATIONS

📄 Fistula with abscess cavity

📄 Fistula with active contrast leak

📄 Fistula with secondary tract formation

📄 Fistula communicating with adjacent organ

BASED ON ETIOLOGY (SUGGESTED)

📄 Post-obstetric fistula

📄 Post-surgical fistula

📄 Inflammatory fistula

📄 Infective fistula

📄 Rectal Fistula

📄 Pere anal Fistula

📷 Insert Image

Patient Info

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Name:

Age (years):

Sex: Female Male Other

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✍️ Footer & Signatures

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End of Topic

You have reached the end of this First-Trimester Ultrasound topic.

Content is intended for educational, training, and clinical reference only.

Declaration:
I, R. K. Mouj, declare that the material presented in this Fistulogram report template has been prepared solely for educational and academic purposes. All procedural steps, fistulous tract outlines, contrast flow patterns, site and extent of communication, and example observations provided are illustrative in nature. Clinical correlation, relevant investigations, follow-up imaging where indicated, and professional clinical judgment are essential before making any diagnostic or management decisions.

Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Radiography & Contrast Imaging
Procedure: Fistulogram
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology

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