Fistulas are abnormal communications between two epithelial-lined surfaces. Gastrointestinal fistulas encompass all such connections that involve the alimentary tract, and they can be congenital or acquired in nature. This review focuses on acquired gastrointestinal fistulas. Development of an acquired gastrointestinal fistula can greatly affect patient outcome, yet the clinical manifestations are often protean in nature and the etiology, elusive. Imaging plays an important role in the detection and management of acquired gastrointestinal fistulas. The more routine use of cross-sectional imaging (especially computed tomography and magnetic resonance imaging) has altered the standard sequence of radiologic evaluation for possible fistulas, but fluoroscopic studies remain a valuable complement, especially for confirming and defining the anomalous communications. In this review, a classification scheme for gastrointestinal fistulas is provided, major causes are discussed, and individual fistula types are elaborated with an emphasis on contemporary imaging approaches.

Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation.

Although computed tomography (CT) is not routinely indicated in uncomplicated renal infection, it is of value in establishing the diagnosis in equivocal cases, in evaluating high-risk patients, and in determining the extent of disease. Unenhanced CT is useful in demonstrating gas, calculi, parenchymal calcifications, hemorrhage, and inflammatory masses. However, a contrast material-enhanced study is essential for complete evaluation of patients with renal inflammatory disease to demonstrate alterations in renal excretion of contrast material that occur as a result of the inflammatory process. In severe acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal areas of hypoattenuation with loss of the corticomedullary interface. Delayed CT scans obtained during the excretory phase are frequently more helpful than early CT scans in defining the extent of the disease process, identifying complications such as renal abscess, and confi...

CT of renal inflammatory disease.

The urinary tract is one of the most common sites of infection in humans. Acute pyelonephritis in children usually occurs because of UTI associated with VUR, while in adults, frank re ̄ux is rarely detected. Women of < 50 years of age are more commonly affected by acute pyelonephritis than men. When older than this, the incidence of UTI in men increases as a result of urinary stasis secondary to prostatic hyperplasia and other factors [1,2]. Acute pyelonephritis is a bacterial infection of the kidney that causes a tubulo-interstitial in ̄ammation of the renal parenchyma. Acute renal infection is of varying severity, from uncomplicated acute pyelonephritis through progressively worsening stages of interstitial in ̄ammation to frank abscess formation [3,4]. Because histological specimens are dif®cult to obtain, exact clinical correlation with these various stages of in ̄ammation is impossible. Therefore, the primary goal of renal imaging is to provide information about the nature and extent of the disease and to identify signi®cant complications, e.g. gas-forming infection, abscess and urinary obstruction [2,3,5±15]. This article presents a review of the current role of and controversies in imaging the kidneys to evaluate patients with acute renal infection. The nomenclature in describing the extent of the renal imaging ®ndings in acute pyelonephritis suggested by Talner et al. is used, as described below [2].

Imaging in acute renal infection

Radiologic evaluation of patients with renal infections

The current roles and controversies in imaging of the kidneys for the evaluation of patients with acute renal infection are reviewed. The nomenclature used in describing the extent of the renal imaging findings in acute pyelonephritis suggested by the Society of Uroradiology to help avoid confusion in terminology in the past literature is briefly described. Computed tomography (CT) is superior to urography and renal sonography for the evaluation and management of adults with acute renal infection. [99mTc]-dimercapto succinic acid (DMSA) cortical scintigraphy is the imaging study for the evaluation of children with acute pyelonephritis investigated by some, although power Doppler ultrasound, and even CT, can be considered as a possible alternative.

Current roles and controversies in the imaging evaluation of acute renal infection

Three patients with renocolic fistulas are presented. Antegrade or retrograde pyelography showed the fistula in one patient but was unsuccessful in two others. CT demonstrated perinephric inflammation extending to the colon, complex air-fluid collections within the kidney, or extension of renal contrast into the colon. CT and direct pyelography complement each other for the diagnosis of renocolic fistulas.

Renocolic fistulas : complementary roles of computed tomography and direct pyelography

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Renocolic fistulas : complementary roles of computed tomography and direct pyelography