Guided tour of hidden tracts in the pelvis: exploring pelvic fistulas

Abstract

Abstract Background Fistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost invariably significant associated morbidity and impact on a patient’s quality of life. Imaging may aid in the diagnosis of pelvic fistulas and is essential to identify any associated pathology, define the course of the fistula, and aid in pre-surgical planning. Purpose This article aims to review the wide array of clinical and imaging presentations of fistulas in the pelvis, with a focus on the radiologists’ role in managing this challenging entity. Methods This article will review each classification type of fistula. Results Pelvic fistula is a devastating condition that causes significant morbidity and evaluation can be challenging. Conclusions Imaging, and particularly MRI, plays a vital role in the diagnosis, characterizing the course of a fistula and demonstrating associated complications, which are essential to guide treatment decisions.