Detection and localization of an occult vesicoenteric fistula

Detection and localization of an enterovesicular fistula in a patient with chronic inflammatory bowel disease and recurrent urinary tract infection was accomplished by following a bolus of orally administered gold colloid as it traversed the gastrointestinal tract with serial scintiphotos and simultaneously monitoring the activity in the urine. When significant tracer was found in the urine, multiple scans of the abdomen where obtained to determine the location of the tracer. To confirm the site of the fistula, the tracer was mixed with barium and administered per rectum. Radiographs were obtained when significant activity was found in the urine. At surgery, bowel in the region of the cecum was adherent to the bladder, but no fistula was demonstrable by methylene blue instillation into the bladder. Postoperatively, the urinary tract infection cleared, and reexamination with oral Au¹⁹⁸ colloid revealed no activity in the urine. The radiation dose to the gonads from this procedure is 42 mrads. The procedure is safe, simple to perform, well tolerated, and permits an answer to the question of whether a fistula is present, and where it is located.