Incidental Finding of a Rectovesical Fistula on Bone Scan: A Case Report

在骨骼掃描影像上偶然發現直腸膀胱瘻管：一病例報告

翁瑞鴻(Jui-Hung Weng) ； 李永康(Jong-Kang Lee)

《核子醫學雜誌》 19卷4期 (2006/12) Pp. 253-257

https://doi.org/10.6332/ANMS.1904.005

摘要

直腸膀胱瘻管是腸道與泌尿道閒癢管的一種類型，較易發生於於該區域的腫瘤或創傷的患者。吾人報告一直腸癌患者經化學與放射線治療後發生了反覆的泌尿道感染與水性腹瀉。在手術前的鎝－99m-MDP骨骼掃描影像發現骨盆部有異常的念珠狀骨骼外攝取，由型態與走向研判為直腸膀胱瘻管。顯影劑增強的電腦斷層攝影顯示一致的發現，最後並由膀胱鏡直接證實直腸膀胱瘻管的存在。骨骼掃描雖不被建議作為疑似腸道與膀胱瘻管的病例的例行檢查，但因在骨骼掃描影像上發現腸道與膀胱瘻管的機會不少，骨骼掃描仍在此類患者扮演一定角色。吾人應有此認識，方能在遭遇此種影像時作出正確的判讀。

關鍵字

直腸癌 ； 直腸膀胱瘻管 ； 骨骼掃描

並列摘要

Rectovesical fistula is a subgroup in the entity of enterovesical fistulas. Virtually all rectovesical fistulas are secondary to cancer or trauma. The case we presented is a patient of rectal cancer, who developed recurrent urinary tract infection and watery diarrhea after neoadjuvant chemoradiation therapy. On the preoperative bone scan an abnormal extraosseous (superscript (superscript 99m)Tc-MDP uptake was noted in the pelvis. Rectovesical fistula was impressed based on the pattern and orientation. Contrast-enhanced CT scan revealed a consistent finding. Finally the presence of fistula was directly proved by cystoscopy. Although bone scan is not recommended as the method of choice to confirm the diagnosis, it still plays a role in the diagnosis and management of such patients for this incidental finding. We should have the idea so that a correct interpretation can be made whenever it is encountered.

並列關鍵字

rectal cancer ； rectovesical fistula ； bone scan