E1202. Pictorial Review of Acquired Colonic Fistulas
  1. Woongsoon Choi; University of Texas Medical Branch
  2. Gabriel Calles; University of Texas Medical Branch
  3. Samuel Krider; University of Texas Medical Branch
  4. Jennifer Kohlnhofer; University of Texas Medical Branch
  5. Magaret Skaug; University of Texas Medical Branch
  6. Cihan Duran; University of Texas Health Science Center at Houston
  7. Sergio Klimkowski; University of Texas Medical Branch
Colonic fistulas may occur at any location along the colon with various imaging appearances. Common etiologies of colonic fistulas include iatrogenic causes, inflammatory processes, infections, and neoplasms. Early detection of fistulas is important in patient’s management due to high morbidity. Radiologic modalities such as fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can be used for detection and post-treatment evaluation of colonic fistulas. In this exhibit, we present common imaging findings of colonic fistulas and showcase interesting cases collected at our institution.

Educational Goals / Teaching Points
At the end of this educational exhibit, the audience will understand the importance of recognizing colonic fistulas, general multimodality imaging features, and common anatomic locations of colonic fistulas.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The common anatomic locations of colonic fistulas are categorized as follows: 1) colon to other portions of the alimentary tract 2) colon to genitourinary tract 3) colon to skin and 4) colon to epithelialized structures such as abscesses, cysts, neoplasms, or necrotic cavities. The most direct method to identify a colonic fistula is by depicting a contrast opacified fistulous tract via fluoroscopy e.g. barium enema or fistulogram. The imaging appearance of a fistula on CT or MRI is generally described as an air- or fluid-filled enhancing “tram-tract”.

Early detection of colonic fistulas is imperative in patient management. Radiologists must know the common imaging features of fistulas and be familiar with diverse anatomic locations of fistulas for timely and accurate assessment.