61-year-old female with rectovaginal fistula, hypertension, CAD PELVIS:UTERUS, ADNEXA: Small amount of fluid within the endometrial canal. Marked thickening and enhancement of the vaginal walls diffusely. The ovaries are not definitely identified. T2 cystic lesion left of the uterus may be a paraovarian cyst.BLADDER: Bladder wall thickening may be partially secondary to under distention.BOWEL, MESENTERY: A large colovaginal fistula with gas and fluid is identified extending from the sigmoid colon to the posterior wall of the vagina. At a more proximal level, there is mild T2 linear signal extending from the anterior wall of the sigmoid colon to the posterior wall of the upper vagina/cervix raising question of a second fistula (series 6, image 21). There is marked diffuse sigmoid colon and rectum wall thickening and enhancement. Bilateral, enhancing and necrotic exophytic soft tissue lesions are noted extending into the adjacent ischioanal fat compatible with necrotic tumor.Focal mildly T2 hyperintense sigmoid colon wall thickening is noted on the right.A left lower quadrant ostomy is identified.BONES, SOFT TISSUES: Asymmetric edema type signal is noted within the pelvic musculature including the iliacus, right greater than left obturator internus, and piriformis musculature. Edema signal is also noted in the gluteal cleft and perineal regions.OTHER: Small amount of free fluid within the pelvis. Partially imaged mild right hydroureter.
1.Large colovaginal fistula with gas and fluid is identified extending from the sigmoid colon to the posterior wall of the vagina. Additional 2nd more proximally located fistula suggested near level of cervix.2.Multiple exophytic enhancing and necrotic appearing lesions arising from the rectosigmoid colon compatible with necrotic tumor invading the adjacent soft tissues.3.Asymmetric edema type signal is noted within the pelvic musculature, e.g., the iliacus, right greater than left obturator internus, and piriformis musculature.4.Partially imaged mild right hydroureter may reflect an element of associated urinary obstruction. 