Case Author(s): M. Quinn, MD and M. Mintun, MD , 01/30/98 . Rating: #D2, #Q4

Diagnosis: GU-GI fistula

Brief history:

61 yo male with back pain


Anterior and posterior images are shown

View main image(bs) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: GU-GI fistula

Full history:

61 year old male with prior cystectomy and diverting colostomy for transitional cell carcinoma of the bladder with colonic invasion and obstruction. Patient had a surgically created neobladder formed from a large segment of ileum. He recently was experiencing back pain and bone scan was done to exclude osseous metastatic disease.




There is no evidence for osseous metastases. However, there is abnormal radiopharmaceutical accumulation throughout the large bowel from the right colon to the site of the diverting colostomy.


Obviously, the presence of radiopharmaceutical in the colon is abnormal on delayed images from a bone scan. This appearance can be caused by previous administration of other imaging agents normally excreted through the GI tract (ie Tc99m-Sestamibi). The patient had no such history. Given his history of bladder carcinoma and extensive surgical treatment the most likely cause of these finding are from a fistulous connection between his neobladder or ureters to the right colon. This could be secondary to either tumor infiltration or breakdown of the anastomosis. .


A subsequent IVP revealed a fistulous connection from high in the ilieal conduit to the right colon at the site of surgical clips in the right lower quadrant, suggesting breakdown of a prior anastomosis. As urine leakage occurred late in the course of the IVP, it was thought that urine diversion to the colon occurred only at higher pressures in the neobladder/ileal conduit. Therefore, an indwelling catheter was placed to keep the GU system decompressed, in hopes the fistula would heal without further surgical intervention.

View followup image(gu). Anterior delayed image from IVP

Differential Diagnosis List

Previous nuclear medicine study with tracer normally excreted via bowel. Urine ingestion (Yes, its been reported!)

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Genitourinary System, Category:Neoplasm, Neoplastic-like condition)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: bs089

Copyright by Wash U MO