Incidental Finding of A Rectovesical Fistula on Bone Scan: A Case Report

Received 7/4/2006; revised 9/29/2006; accepted 9/29/2006. For correspondence or reprints contact: Jui-Hung Weng, M.D., Department of Nuclear Medicine, Chung Shan Medical University Hospital, 110 Section 1, Chien Kuo North Road, Taichung 402, Taiwan, ROC. Tel: (886)4-24739595 ext. 32002, Fax: (886)4-24718073, E-mail: [email protected] Rectovesical fistula is a subgroup in the entity of enterovesical fistulas. Virtually all rectovesical fistulas are secondary to cancer or trauma. The case we presented is a patient of rectal cancer, who developed recurrent urinary tract infection and watery diarrhea after neoadjuvant chemoradiation therapy. On the preoperative bone scan an abnormal extraosseous TcMDP uptake was noted in the pelvis. Rectovesical fistula was impressed based on the pattern and orientation. Contrast-enhanced CT scan revealed a consistent finding. Finally the presence of fistula was directly proved by cystoscopy. Although bone scan is not recommended as the method of choice to confirm the diagnosis, it still plays a role in the diagnosis and management of such patients for this incidental finding. We should have the idea so that a correct interpretation can be made whenever it is encountered.