Clinical Presentation

A 68-year-old woman presents with a past history of ovarian carcinoma.

Dynamic proctography shows a single fistulous tract from the sigmoid colon to the vagina. Delayed image shows the fistula (large arrow), contrast in the vagina (small arrow), and leakage of contrast to the perineum. The sigmoid colon is circumferentially narrowed, and several diverticula are present (arrowheads).

Differential Diagnosis

• Diverticulitis causing colovaginal fistula: Sigmoid diverticula, diverticular disease (with circumferential luminal narrowing), and the proximity of the fistula to the abnormal segment of sigmoid colon place diverticulitis at the top of the list for diagnosis.

• Malignancy: This is a possible second; recurrence of the patient’s ovarian cancer, new colon cancer, and other invasive pelvic neoplasms may cause fistulae.

• Surgery: Fistulae can be a complication of surgery; treatment for prior malignancy raises this possibility.