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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 427-428
A case of jejunouterine fistula


S.S.G. Hospital, Medical College Baroda, Vadodara, Gujarat - 390001, India

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   Abstract 

Jejunouterine fistula is an uncommon type of fistulous communication between the gastrointestinal tract and genital tract. A case of 40 years old female who developed such fistula following check curettage after vaginal delivery is reported. Importance of cross sectional imaging like ultrasonography, CT and MR and possible etiological factors are discussed.

Keywords: Jejunouterine Fistula, Fistula, Enterouterine Fistula

How to cite this article:
Vorha P A, Kumar Y, Raniga S, Vaidya V, Verma S, Mehta C. A case of jejunouterine fistula. Indian J Radiol Imaging 2005;15:427-8

How to cite this URL:
Vorha P A, Kumar Y, Raniga S, Vaidya V, Verma S, Mehta C. A case of jejunouterine fistula. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Feb 21];15:427-8. Available from: http://www.ijri.org/text.asp?2005/15/4/427/28764

   Case report Top


Here we report the case of a 40 year old female who presented with the history of discharge of the semi digested food particles pervaginum and palpable lump in the left paraumblical region .She had a history of preterm vaginal delivery 6 weeks ago followed by check curettage done to look for the retained products.

Ultrasonography of the patient showed the presence of the thickened matted bowel loops in left paraumblical region in close proximity to fundus of the bulky uterus [Figure - 1]. Linear echogenic foci with dirty aftersahadowing were present in the endometrial cavity and a hypoechoic track was seen between the endometrial cavity and the matted jejunal loops. CT scan was performed to confirm jejunouterine fistula.

Plain CT showed air in the endometrial cavity and oral contrast was seen to pass into the endometrial cavity .Contrast filled fistulous tract is also demonstrated between the jejunal loop and the fundus of the uterus. The jejunal bowel loops lying adjacent to the fundus of the uterus were found to be thickened [Figure - 2],[Figure - 3],[Figure - 4]. The diagnosis of the jejunouterine fistula was established. Peroperatively a fistulous communication was found between jejunal loop and the fundus of the uterus .The jejunal loop with fistulous connection and the uterus were resected and jejunojejunal anastomosis was performed.


   Discussion Top


Communication between the gastrointestinal and genital tracts is a type of extraintestinal internal fistula. Vagina is commonly found to be affected while involvement of uterus is rarely reported [2]. Gynecologic and obstetric procedures and surgeries are most frequent causes of such fistulae [1]. Two factors need special mention i.e. its anatomic location and the volume of output it produces. More proximal communication with small bowel produces larger output and leads to more severe electrolyte disturbance and malabsorption [2].

Hysterosalpingography can be helpful in the detection of the fistula. Transvaginal US has also been successfully employed by some authors. Cross-sectional imaging, like computed tomography (CT), has further improved the radiologist's vision. CT has the ability to demonstrate extraluminal disease, including associated abscesses, tumor, or other coexisting processes and helps in guiding the surgical procedure. According to literature, though CT is less sensitive in direct detection of some of GI fistulae, it excels in detecting enterovesical fistulae. MR is mainly used in enterocutaneous fistulae in the perineal region. [2]

Treatment depends on the nature of the fistula. Medical management includes Metronidazole and 6-mercaptopurine (6-MP), an immuno-modulator, and parenteral alimentation. Surgical therapy includes resection of the diseased bowel and end to end anastomosis .Temporary ileostomy may also be required in some cases.

Wide ranging etiologies cause fistulae involving the gastrointestinal tract and genitourinary tract. However common offenders are chronic infections, neoplasms, congenital conditions and iatrogenic trauma. Imaging plays a crucial role in delineating the anatomy and extent of the fistulous tract. In addition to contrast enhanced studies under fluoroscopy, cross sectional modalities such as sonography, CT and MR imaging have proved to be useful. The volumetric and multiplanar capabilities of MR imaging and the modern CT systems simplify the diagnosis. Radiologist must be familiar with the radiologic findings for both accurate diagnosis and in many cases, guidance of management planning [1].

 
   References Top

1.Nam C. Yu, MD, Steven S. Raman, MD, Monica Patel, MD and Zoran Barbaric, MD Fistulas of the Genitourinary Tract: A Radiologic Review Radio Graphics 2004; 24:1331-1352  Back to cited text no. 1    
2.Perry J. Pickhardt, MD, Sanjeev Bhalla, MD and Dennis M. Balfe, MD Acquired Gastrointestinal Fistulas: Classification, Etiologies, and Imaging evaluation Radiology 2002; 224:9-23.  Back to cited text no. 2    

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Correspondence Address:
P A Vorha
B/103, Sapan flats, Near Mother's School, Near Harinagar Road, Gotri, Baroda.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28764

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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