40 year-old female with history of ulnar cancer and rectovaginal fistula presenting with gas from vagina now concerning for rectovaginal fistula. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated proximal small bowel loops with relatively decompressed distal small bowel loops. There is a paraumbilical hernia containing small bowel segments and the hernia may be the cause of this mild partial small bowel obstruction. No evidence of perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Endometrial cavity is distended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Infiltrative, soft tissue density around the rectum and in the bilateral ischiorectal fossa. There is a possible communication between the vagina and rectum on the right side. However MRI of the pelvis will be much better for depiction of the fistulous tract.
Possible rectovaginal fistula on the right. MRI of the pelvis may be helpful for better depiction of the fistulous tract. Dilatation of the endometrial cavity. Perirectal inflammatory changes.Possible mild small bowel obstruction. The etiology is unknown but may be related to the periumbilical hernia containing small bowel segments.