title: Lethal hemorrhage from a ureteric-arterial-enteric fistula diagnosed by postmortem CT angiography.
abstract: Fistula formation following pelvic surgery and radiotherapy, including ureteric-arterial fistulas (UAF), is well documented, however, ureteric-arterial-enteric fistula is extremely rare. Conventional autopsy is usually required for the definitive diagnosis of pelvic vascular fistulas although an accurate diagnosis can still be complicated and challenging. The role of post-mortem computed tomography (PMCT) as an adjunct to conventional autopsy is well documented in the literature. One of the limitations of PMCT is the diagnosis of vascular conditions. Post-mortem computed tomography angiography (PMCTA) is a recently introduced technique that can assist in detecting such pathology. We present a case of post-radiotherapy ureteric-arterial-enteric fistula presenting as massive rectal and vaginal bleeding diagnosed prior to autopsy on PMCTA. The role of PMCTA in the diagnosis of such a UAF has not previously been reported in the literature.
authors.affiliation: Department of Radiology, University Putra Malaysia, Selangor, Malaysia. drsnar72@gmail.com
authors.forename: Saiful Nizam bin Abdul
authors.initials: SN
authors.lastname: Rashid
authors.forename: Heinrich
authors.initials: H
authors.lastname: Bouwer
authors.forename: Chris
authors.initials: C
authors.lastname: O'Donnell
mesh_terms: D000368:Aged; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D049429:Forensic Pathology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D007412:Intestinal Fistula / Q000175:diagnosis*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000000981:diagnostic imaging / Q000473:pathology; D014548:Urinary Fistula / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000473:pathology; D016157:Vascular Fistula / Q000175:diagnosis*; D051598:Whole Body Imaging
chemical_list: D003287:Contrast Media