Rectourethrocutaneous fistula in Crohn disease

Fistulae from the gastrointestinal tract to the urinary tract are a well-known complication of Crohn disease. The majority of these are ileovesical. On rare occasion, patients with perianal complications of regional ileitis or granulomatous colitis may develop rectourethrocutaneous fistulae. The authors have encountered 2 such patients and add them to the 3 previously reported cases in the English literature. Retrograde urethrography and voiding cystourethrography established the diagnosis.     

Colosalpingeal fistula: a rare complication of colonic diverticular disease

Diverticular disease is a common condition in Western countries. The formation of inflammatory fistulae, usually from sigmoid colon to bladder or vagina, can be a feature of complicated cases of the disorder and is normally an indication for surgical intervention. We present a case of colosalpingeal fistulation occurring secondary to diverticulitis, a complication which, to our knowledge, has not been previously reported in the radiological literature. As in this instance, the initial clinical presentation of this problem can often be non-specific, with localising symptoms occurring later. In our case, barium enema examination allowed good demonstration of the fistulous communication before the more specific symptoms were clinically apparent. Received: 29 July 1998; Revision received: 29 October 1998; Accepted: 4 November 1998     

Carcinoma of the small intestine and colon as a complication of Crohn disease: radiologic manifestations

Barium examinations of the large and small bowel were analyzed in six of seven patients who had adenocarcinoma in areas of the intestine affected with Crohn disease; radiographic changes were correlated with clinical, surgical, and pathologic findings. Radiographic examinations were available in five of these patients at the time of diagnosis of tumor. Two of the five patients demonstrated classic radiographic changes associated with carcinoma. In the other three cases, the radiographic changes were atypical for carcinoma and demonstrated progression of disease over time to include more portions of the bowel and presence of fistulas, strictures, and obstruction. The most frequent clinical presentation of adenocarcinoma in these patients was a recrudescence of symptoms after a long quiescent period. In patients with long-standing Crohn disease plus these clinical features and the above radiographic findings, the diagnosis of a coexisting carcinoma should be considered.     

Desbaric air embolism during diving: an unusual complication of Osler-Weber-Rendu disease

Cerebral manifestations of Osler-Weber-Rendu disease (OWRD, hereditary haemorrhagic telangiectasia) including telangiectases, venous malformations, and arteriovenous malformations, are usually under-recognised. The highest complication rate is observed in high flow cerebral arteriovenous malformations, which may present with headache, epilepsy, ischaemia, or haemorrhage. Cerebral air embolism during self-contained underwater breathing apparatus (scuba) diving as the first manifestation of pulmonary arteriovenous malformation (PAVM) in OWRD patients has never been reported before. Here we report a 31 year old male who presented desbaric air embolism as the first manifestation of PAVM. As far as we know, this is the first such case published in English medical literature.     

Gastrosplenic fistula: complication of adenocarcinoma of stomach

Penetration of the spleen by an adenocarcinoma of the stomach is described in a patient undergoing chemotherapy. The diagnosis was made by computed tomography.     

Ileourethral fistula following cystectomy: A rare complication

Fistulae between the urinary and intestinal tracts of adult male patients usually result from trauma, inflammatory diseases, necrosis and infiltration of a neoplasm of either the bladder, prostate or colon, or radiation therapy. We report 2 patients who developed an ileourethral fistula following cystectomy which had been performed for carcinoma of the bladder in 1 patient and leukoplakia of the bladder in the other. The diagnosis of an ileourethral fistula was established by retrograde urethrography and a barium follow-through study. Computed tomography performed in 1 patient showed a tumor mass in the pelvis.     

Colobronchial fistula: a late complication of childhood radiotherapy

We present the case of a colobronchial fistula in a 41-year-old man who underwent radiotherapy for nephroblastoma as an infant. He attended for barium enema, which demonstrated a fistula between colon and bronchial tree. Following right hemicolectomy and pathological examination of the resected bowel, no active disease process was identified to explain the development of this rare fistula. Radiotherapy was deemed the most probable aetiology. We are unaware of this having been previously described.     

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.     

Abscesses in Crohn disease: percutaneous drainage

Fifteen patients with Crohn disease underwent percutaneous catheter drainage of related abdominal abscesses. The abscesses were located in the right lower quadrant (five patients); in the quadratus lumborum and/or iliopsoas muscles (four patients); in the left paracolic gutter (two patients); and in the right gluteal muscles, the liver, the left subphrenic space, and the pelvis (one patient each). All abscesses were evacuated successfully (n = 15 of 15), and no patient required surgery for abscess drainage. Existing fistulas closed in four of seven patients; the other three patients underwent surgery for excision of diseased bowel and enteric fistulas. No patient developed an enterocutaneous fistula as a result of catheter drainage. Percutaneous abscess drainage is effective for abscesses related to Crohn disease and should be regarded as the procedure of choice. An operation for the abscess can be avoided, and early results suggest that bowel surgery may be obviated in selected patients.     

Echotomography in Crohn disease

The authors report their experience in 40 patients with intestinal Crohn's disease, who underwent both abdominal ultrasound scanning and double-contrast small bowel enema. The various echographic patterns are described, found in the different phases during the evolution of Crohn's disease, underlying the importance of ultrasound in evaluating the real degree of bowel wall thickening and the exo-enteral space, only indirectly appreciated with X-ray examination.     

Orbital emphysema: an unusual complication of balloon dacryocystoplasty

Balloon dacryocystoplasty is a procedure used in the treatment of partial nasolacrimal duct obstruction. A case of orbital emphysema following one such procedure is reported here. The risk factors associated with this rare event are highlighted.