Rectovesical Fistula Palliation — SCE Palliative Medicine MCQ
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Correct answer: E — Prophylactic antibiotics for UTI prevention, skin integrity care, catheterisation if needed for comfort, and supportive counselling — surgical repair is rarely suitable in advanced disease
Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E
In incurable, advanced colorectal cancer with symptomatic rectovesical fistula, palliative care principles favour conservative symptom control—preventing UTIs, maintaining skin integrity, catheterising if distressing, and providing supportive counselling—over invasive procedures. The RUH Waik palliative care handbook advises containment and symptom control measures and specialist palliative input in this scenario ([ruh.nhs.uk](https://www.ruh.nhs.uk/For_Clinicians/departments_ruh/Palliative_Care/documents/palliative_care_handbook.pdf?utm_source=openai)). NICE also emphasises that advanced colorectal cancer is primarily managed palliatively, focusing on symptom control and psychosocial support, not curative surgery ([nice.org.uk](https://www.nice.org.uk/guidance/ta61/chapter/2-clinical-need-and-practice?utm_source=openai)). Other options are inappropriate: cauterisation (A) is procedural and unlikely to succeed; exenteration (B) is excessively radical and not indicated in incurable disease; emergency colostomy (D) doesn’t address urinary symptoms; bladder washouts (E) lack evidence and may irritate mucosa further.
Reference: RUH NHS Palliative Care Handbook – Fistulae management (2026), NICE TA61 – Advanced colorectal cancer palliative management (2003, reviewed 2026), https://www.ruh.nhs.uk/For_Clinicians/departments_ruh/Palliative_Care/documents/palliative_care_handbook.pdf