E1783. Train Your Brain: Amazing Adult Cases of Digestive System Fistulas
  1. Claudia Moldovanu; Emergency Clinical County Hospital ; The University of Medicine, Pharmacy, Science and Technology of Târgu Mures
  2. Bianca Petresc; Emergency Clinical County Hospital ; The University of Medicine, Pharmacy, Science and Technology of Târgu Mures
  3. Cosmin Caraiani; Regional Institute of Gastroenterology (IRGH) ; University of Medicine and Pharmacy “Iuliu Hatieganu”
  4. Andrei Lebovici; Emergency Clinical County Hospital ; University of Medicine and Pharmacy “Iuliu Hatieganu”
Digestive system (DS) fistulas represent abnormal ductlike communications between the gut and another epithelial-lined surface. The etiology may be related to postoperative complications, malignancy, inflammatory bowel disease, radiation therapy, iatrogenic or traumatic causes.

Educational Goals / Teaching Points
This educational exhibit will discuss some concepts of DS fistulas. There will be reviewed key imaging findings of 10 interesting adult cases of digestive system fistulas and will be discussed significance of imaging findings and management. Then some concepts about common fistulas involving the digestive tract will be discussed through a case-based review.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The first diagnostic step in a patient suspected of having a DS fistula is a thorough examination and medical history. DS fistulas can be congenital (will not be considered further) or acquired in nature. Acquired DS fistulas can be categorized as: - external: communicate with the skin surface - internal: connect to another internal organ system or space - include two types: intestinal and extraintestinal. Intestinal fistulas - a gut-to-gut connection (any combination of stomach, small bowel, and colon). Extraintestinal fistulas - communication of the GI tract with another organ system (genitourinary system, biliary tree, or respiratory tract). Complex fistulas contain both internal and external components.

DS fistulas comprise a fascinating spectrum of clinical entities that remain a serious diagnostic challenge. The radiologist should be familiar with the imaging findings because these fistulas are a devastating condition that cause significant morbidity. Accurate characterization of the location of fistulous tracks and associated complications are vital for surgical planning.