Fig. 14

An 80-year-old woman with a history of endometrial carcinoma and ovarian carcinoma treated remotely with pelvic surgery and RT presenting with clinical symptoms of vaginal-enteric fistula. Initial CECT axial images (a) depict abnormal gas within the thickened vagina (open white arrow) which is in close proximity to both pelvic small bowel loops (SB) and sigmoid colon (SC). A colovesical fistula was suspected. Barium enema was subsequently performed (b) to confirm the findings. Overhead AP image from single contrast barium enema fails to demonstrate communication between the colon and vagina. Note short segment persistent narrowing of the sigmoid colon (black arrow) with tapered margins and preserved mucosal folds (not shown) consistent with radiation induced stricture. Direct vaginography was suggested for further evaluation. Oblique radiograph from direct vaginogram depicts maximal distention of the vagina (V) and residual barium in the sigmoid colon (SC) with uncomplicated diverticulosis. There is abnormal filling of pelvic small bowel loops (black circle). The findings were in keeping with fistula between the distal ileum and vagina