What is the proper diagnostic machine to see a tear or fistula in the digestive tract or reproductive organs?

A CT Scan can be done with or without contrast and may be able to show a tear or fistula. They can also be done with dye in the blood stream to look for bleeding (like an angiogram) in the GI tract. An MRI can be done to get a better picture of what was seen on a CT Scan, but may not notice a small tear.

The best way to look for a tear or fistula would be with endoscopy.

For the GI tract, a fluroscopy X-ray with barium such as a barium swallow or a barium enema depending on where the tear is suspected.

If there is a suspected tear in the GI tract that makes a hole all the way through the bowel then an endoscopy would probably not be indicated as it could make things worse.

Hoping you also know about anatomy. It seems to be the uteris only has an opening through the cervix into the vagina, right? And then the vagina two, one to the cervix as pointed out and then the opening to the exterior of the body? Would the only way to get abnormal flora in the vagina or uteris be if there was some sort of fistula from the digestive tract, or even from around the digestive organs from the abdominal cavity somehow? For this question please assume STD or any infection from the outside as impossible, I only am interested in an infection due from the body itself.

@JLeslie Assuming the abnormal flora did not come from the vaginal opening, it could be assumed that it came through a fistula of some kind. However, to get abdominal flora (the stuff normally found in the GI tract) into the uterus, you would need a fistula in both the GI tract and the uterus.

@Seaofclouds So, there is not flora surrounding the organs that could get in if the fistula was just on the reproductive organs? I would think if there was a fistula, or some sort of odd connecting tissue/tube like growth of some sort that flora directly from the intestines would easily culture as abnormal flora, showing ecoli which I believe grows readily. The situtation I am talking about doesn’t show abnormal aerobic flora, but an infection is obviously present.

I don’t think there is any normal flora in the abdominal cavity, but I could be wrong. There could be an abnormal growth between the GI tract and the uterus that could allow the transfer of normal abdominal flora to the uterus, but that would be very rare and would show up on a culture.

When you say an infection is obviously present, what are the symptoms? Does the culture show any results? There are other illnesses that can have similar signs and symptoms as an infection.

A thoracic fistula, such as a tracheo-oesophageal fistula, is best seen with a barium swallow. However it is generally performed with the patient prone, since the oesophagus is posterior to the trachea, and the barium needs to travel through the fistula. Great care must be taken to make sure the barium does not enter the lungs as well, since it can settle and set hard.

An abdominal GIT fistula would be best seen with a CT virtual colonoscopy or colonography. These are non-invasive tests that do not require contrast. The patient is required to drink a large amount of water to distend the bowel, but apart from that it is very similar to a normal CT abdomen scan. A single-contrast barium enema may also be a good test, but it is more invasive and more uncomfortable for the patient.

A uterine fistula can be demonstrated on ultrasound trans-vaginal scans, which I would expect to be the modality of choice. A CT scan would probably show it as well. The other option would be a hysterosalpinogram (HSG), which involves filling the uterus with contrast. This test is designed to show the uterine wall, specifically as a fertility test, but it is not common any more since it has been largely replaced by ultrasound.

@Lightlyseared – you would NEVER use barium for a suspeted tear or fistula. If there was one, it would leak and cause peritonitis. You would use water based contrast such as gastrografin.

Fire Made Flesh has the correct answer, with the exception of the use of barium. By the way, I am a lecturer in medical imaging, with 27 years experience in the field.

@Harold Thanks for the correction.

@FireMadeFlesh Actually I was just thinking a little while ago I have had an HSG in the past, and I would think the ink spilling into an odd area would give away if there was a fistula. However, my HSG was fantastic, but when I had exploratory surgery I was royally screwed upin there. But, you would also think they would see a fistula during the surgery. Right?.

@JLeslie I have never personally observed an HSG (thank goodness), but yes I would expect it to have shown a fistula. If your surgery was exploratory, they would have inspected the whole surface of the wall, so it should have seen it too – but that is only my guess, those surgeries don’t need imaging guidance so I know little about them.

Have you had a culture done to confirm that it is an infection? It may be possible for an infection to have come from the skin, in a similar manner to a Urinary Tract Infection (UTI). The uterus is acidic, which manages to prevent most infections, so maybe you have an underlying problem that has changed the pH and allowed bacteria to survive. This is my hunch, but it would need to be confirmed by someone with more expertise than myself.

pH is always perfect. Cultures perfect, except one lab does come up with A. Meyeri at times, specialized lab for this sort of thing, regular labs always say I am fantastic. I really think it is some undiscovered thing. Like how Chlamydia used to be considered normal flora. This has been going on for many many years, I don’t want to go into my whole history on the thread, so I am leaving out some details. I have a doctor suggesting a CT, and I have not agreed to it, because first I want to make sure that would be the most likely imaging to work, because I hate xrays. And, two, I have to pay for it, so if an MRI is going to better for some reason, even if it is more expensive, it would be better than paying for both a CT and an MRI. Lastly, I have not agreed, because I think it would have been seen during my surgery, but the surgeon was not looking for something like that, but he was specifically there to examine my reproductive organs. I don’t have confidence this other doctor (the one suggesting a CT scan, he is Infectius Disease by the way) really paid attention to all I said, because he suggested an antibtioc I have tried three times before that never works. So, maybe he is not thinking through that I had an HSG and surgery in the past.

@JLeslie Although I am not familiar with your case (I understand privacy is especially important in such a case), I think you are doing the right thing by refusing a CT scan. Too many times people are referred for imaging so it looks like the doctor has some ideas, when in truth he has none. I’m not sure an MRI would be of much use either, because if your symptoms indicate an infection I don’t think a structural issue would be the cause. It may show inflammation in the area, but that is a symptom and not a cause.

The other important point is that specialists are often only good for their own field of expertise. I heard a story once (that was quite vague, so take it with a grain of salt) where a cardiologist was consulted for arm pains, so the patient was sent for several heart function tests when the problem was in fact in the arm (it may have been carpal tunnel, I don’t really remember). Maybe instead of seeing an Infectious Diseases specialist you should see a Gynaecologist.