FISTULOGRAM

The fistula is an abnormal connection between two hollow structures. The fistula may be congenital or develops after surgery or injury of an organ.

Indication 

• Opening near sutures wound or any body part like anus or vagina.
• Pus , fluid, waste leak from the opening.
• Throbbing pain
• Swelling near the affected area.

Contraindication 

• Hypersensitivity to contrast
• Suspected pregnancy

Equipment

• Fluoroscopy unit with tilting table 
• Local anesthesia
• Catheter 
• Contrast
• Normal saline 
• Gauze 
• Sterile towel 
• Antiseptic solution

Patient  preparation

• The patient should not eat or drink after midnight.
• Patient KFT reports must be reviewed prior to the examination.
• Describe whole procedure to the patient.
• Ask the patient to remove clothing and wear hospital gown. 
• An IV line is inserted into the patient arm and sedative medication is given through line to make patient relax.

Procedure

• Place the patient on the X- ray Fluoroscopic table .
• Clean the fistula with an antiseptic solution.
• Local anesthesia is injected near the fistula for numbing the area.
• Then the radiologist advances a catheter according to the size of fistula into the fistula tract.
• After insertion of a catheter, the radiologist slowly injected 5ml diluted ionic contrast mixed with normal saline into the fistula tract under fluoroscopy guidance.
•  After filling the fistula  tract with the contrast media, several x ray or spot films are taken in AP , Lateral and Oblique position to access the fistula tract.
• After completion of examination the catheter is removed and the wound must be cleaned and covered with the dressing.

Aftercare

• Patient will be allowed to leave the examination room after completion of the examination.