Best technique for the evaluation of colovesical fistula

What is the best technique for the evaluation of colovesical fistula?

CT imaging following the administration of oral contrast material without intravenous contrast material is the best way to evaluate for a colovesical fistula. This eliminates the possibility that positive contrast material seen in the bladder may be from urinary tract excretion of intravenous contrast material as opposed to oral contrast material from the bowel. The presence of gas in the bladder in the setting of active colonic inflammation and no history of recent instrumentation is highly specific for presence of a colovesical (or enterovesical) fistula.


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