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Fistula as Complication of Advanced Rectal Cancer T3/T4, Grade G2, Diagnosed with Contrast-Enhanced Computed Tomography and Magnetic Resonance Imaging

TG Teneva, AK Zlatarov, GD Dyakova, GN Valchev, BD Balev


INTRODUCTION: Patients with rectal cancer may suffer complications, such as rectal fistulas at various stages of diagnostics and treatment. Some present initially with complicated advanced disease. In other cases fistulas are developed after chemo-radiotherapy and/or surgery. The causes of these complications include malignant infiltration and inflammatory changes. Various imaging modalities are used to precisely diagnose the initial stage of the tumour, and to detect the complications of advanced cancer.

CASE SERIES PRESENTATION: We present a case series of five patients with fistulas due to advanced rectal cancer. All five patients are with locally advanced cancer stage T3 and T4; with histological grade G2; all of them underwent contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) of the pelvis for initial diagnosis and follow-up before and after treatment for fistula. All of them had adjuvant or neoadjuvant chemo-radiotherapy and only one of them underwent surgery. The complications were communication fistulas - rectovaginal, rectovesical, rectosacral and rectocutaneous fistulas and we will present one case of postoperative presacral abscess with fistula.

CONCLUSION: Various imaging modalities are used for diagnostics, staging and planning of the treatment of rectal cancer. Both magnetic resonance and computed tomography are excellent imaging tools in the management of rectal neoplasia. The morphologic criteria for investigation/imaging of rectal cancer in the setting of advanced disease are: presence and contrast enhancement of tumour tissue, diameter and volume of cancer, infiltration and extent of tumour tissue and following complications with the most common being fistulas.


rectal cancer, adjuvant/neoadjuvant radiotherapy, complications, computed tomography

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About The Authors

TG Teneva

AK Zlatarov

GD Dyakova

GN Valchev

BD Balev

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