Diagnosis

One of the most essential studies to be carried out is a fistulogram to assess the anatomy of the fistula. If a fistulogram in not possible other means of assessing the fistula can be carried out. The possible localization studies are:

• Gastrografin per rectum - usually required

• Oral gastrografin studies (infrequently required - done if rectal gastrografin study is inconclusive)

• Gastrografin study through the fistula.

The aims of these studies are to locate the level of the fistula, define its type if possible, assess the completeness or otherwise of the rupture, and detect a distal obstruction if present. X-ray films at 3, 6, and 12 hours after transluminal contrast studies may show a delayed filling of an abscess cavity.

For colovesical fistula, cystoscopy is mandatory. Colonoscopy is essential in spontaneous fistula to assess the colonic pathology but is best avoided in the postoperative fistulae.

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