Endoscopic placement of a Foley catheter across a stricture and rectovaginal fistula to perform a barium enema.

Abstract

Evaluation of enteric fistulas is often best performed with barium contrast studies. Clinical situations that preclude the satisfactory installation of barium decrease the yield of the study. A case is presented of a 59-yr-old female with stage III-B cervical carcinoma and a known rectovaginal fistula with an adjacent sigmoid colon stricture. An additional more proximal, enteric fistula was suspected. Definitive preoperative knowledge of the existence or absence of this fistula would have shortened the duration of a planned palliative intervention. The rectovaginal fistula and stricture precluded adequate barium and air installation for contrast study. Colonoscopy was unsuccessful. We have developed a combined technique in which the endoscopic placement of a semirigid guidewire allowed placement of a Foley catheter across the fistula and stricture. Successful barium study was performed. Intraoperative time and hospital stay were shortened.