Right lower quadrant pain and concern for rectovaginal fistula in the setting of vaginal delivery. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel is normal in caliber wall thickness and without adjacent inflammatory changes. The terminal ileum is unremarkable. No free fluid or loculated fluid collection. The appendix is not definitively seen although I suspect it is partially seen in the retrocecal position (series 8/13). No adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and adnexa are unremarkable. Several bilateral physiologic cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace amount of nonloculated fluid in the rectouterine pouch. No evidence of a rectovaginal fistula.BONES, SOFT TISSUES: There is an equivocal focus of linear signal abnormality extending posteriorly from the distal vaginal canal towards the rectum (series 270 0/56, series 19/20, series 5/43) which may represent a very small fistulous communication in light of the given history. OTHER: No significant abnormality noted.
There is an equivocal focus of linear signal abnormality extending posteriorly from the distal vaginal canal towards the rectum which may represent a very small fistulous communication in light of the given history. If clinically warranted a fluoroscopic study with direct instillation of contrast may be of value.No specific findings to account for the patient's right lower quadrant pain. Trace free fluid in the pelvis is within physiologic limits. 