Gastrointestinal Radiology > Procedures > Vaginography > Vaginography (1)


Vaginography

Introduction

Vaginal fistula.
  • is a significant management problem for patients because of the malodorous vaginal discharge and fecal or urinary incontinence.

  • Diverticulitis of the colon is the commonest cause.

  • The thick-walled uterus and its broad ligament serve as an anatomic barrier to the development of colovesical and colovaginal fistulas. Thus, women who have undergone hysterectomy have a much greater frequency of fistulas from diverticulitis.

  • Other causes of vaginal fistulas include sigmoid or rectal cancer, gynecologic malignancy, Crohn's disease, radiotherapy, trauma during pelvic surgery, anastomotic leaks, and blunt pelvic trauma.

 

Vaginography.

  • is superior to all other imaging modalities currently available in its ability to demonstrate the presence and anatomy of high vaginal fistulas.

  • It has a sensitivity of 79-85% and positive predictive value of 100%.

  • This is compared to barium enema with a sensitivity of 9-34% and computed tomography with a reported accuracy of 60%.

  • Vaginography has also been proven superior to small bowel barium studies, charcoal challenge, tandem colovaginoscopy, flexible vaginoscopy, and magnetic resonance imaging.

  • In addition to detecting vaginal fistulas, vaginography has also been used to identify colouterine fistulas and ectopic insertion of a ureter into the vagina.

  • For low vaginal fistulas caused by obstetrical trauma or other perineal trauma, vaginography may be unsuitable because of the Foley catheter balloon being inflated either above the fistula or at the level of the fistula and occluding its orifice.

  • Vaginography is easy to perform, relatively economical, and causes little or no patient discomfort.


© Copyright Rector and Visitors of the University of Virginia 2013