Rectovesical Fistula Diagnosis and Management

Definition and Characteristics

A rectovesical fistula is characterized by an abnormal connection between the rectum and the bladder, creating a pathological tract between these two organs 1
The pathognomonic clinical presentation includes pneumaturia and fecaluria 1
Recurrent urinary tract infections are also a common presenting manifestation of rectovesical fistulae 1

The most common causes of rectovesical fistulae include diverticulitis, Crohn's disease, colorectal or pelvic malignancies, radiation therapy, iatrogenic injury, and postoperative complications 1

CT with intravenous contrast is commonly used to diagnose rectovesical fistulae, with a diagnostic sensitivity of 76.5% for fistula detection and 94.1% for defining the etiology 1
Water-soluble contrast should be placed in the bowel or bladder to opacify fistulous tracts during imaging studies 1
Cystography has shown high detection rates for enterovesicular fistulae in some studies, compared to contrast enema 2
MRI pelvis with IV contrast provides superior contrast resolution for evaluating fistulous tracts and is particularly useful for detecting active inflammation 3

Rectovesical fistulae require specific treatment approaches and often necessitate a multidisciplinary approach 4

It's essential to distinguish rectovesical fistulae from other types of fistulae, such as rectovaginal, colovesical, or ureterovaginal fistulae, as they have different etiologies, presentations, and management approaches 3