Diagnosis Of Perianal Fistula Research Articles

Digital Rectal Examination versus Magnetic Resonance Fistulography in Diagnosis of Perianal Fistula

Digital Rectal Examination versus Magnetic Resonance Fistulography in Diagnosis of Perianal Fistula

A study of the diagnostic efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis of perianal fistula and its complications.

To determine the diagnostic efficacy of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of perianal fistula and its complications. This is a retrospective study based on the data of 47 patients with a clinical diagnosis of perianal fistula, who had an MRI study performed on a 1.5-T GE Signa MR scanner. DWI sequences were done using 3 different b-values. Other routine MR sequences were included. The MR images were studied to compare the diagnostic efficacy of the DW MRI sequence and other sequences in diagnosing perianal fistula and its complications. Apparent diffusion coefficient (ADC) values of abscesses and inflammatory soft tissue lesions were measured using ADC maps. The standard reference to obtain diagnostic efficacy was post-surgical data. Seventy-nine perianal fistulas were diagnosed in 47 patients who had undergone an MRI study. The sensitivity and specificity of different MR sequences in diagnosing perianal fistulas are T2 FSFSE: 92% sensitivity; DWI: 96% sensitivity; combined T2+DWI: 100% sensitivity; and post-gadolinium T1 FS has 100% sensitivity in diagnosing perianal fistulas. The mean apparent diffusion coefficient for the abscess in our study was 0.990 ± 0.05 × 10-3, and the mean apparent diffusion coefficient for an inflammatory soft tissue lesion was 1.440 ± 0.05 × 10-3. The optimal ADC cut-off for the abscess was 1.098 × 10-3 mm2/s showing 100% sensitivity and 93.8% specificity. DW imaging is a reliable sequence to diagnose perianal fistula and its complications. Measurement of ADC values is reliable in diagnosing perianal abscess collection. DWI sequence helps patients with renal impairment in whom IV gadolinium is contraindicated.

Diagnostic Accuracy of Magnetic Resonance Imaging in Detection of Perianal Fistula keeping Surgical Findings as Gold Standard

An abnormal connection between the rectum or canal and the anal skin is called as a perianal fistula (PAF). MRI is considered as a gold standard for the imaging of PAF because of its operator dependence, non-invasive nature, excellent soft tissue contrast, superior field of view and multiplanar capabilities. Objective: To assess the validity of magnetic resonance imaging in detecting perianal fistulas while using surgical findings as the gold standard. Methods: From 1 January 2021 to 30 January 2022, a cross-validation research was carried out in the radiology department at Memon Medical Institute Hospital in Karachi, Pakistan. The research comprised 153 individuals with PAF ranging in age from 18 to 70 years and of either gender. A 1.5 T MR scanner was used to obtain the MRI. All techniques used a phased-array coil for image capture in all circumstances. The imaging volume encompassed the distal rectum, anal canal, and subcutaneous tissues. Fat saturation pictures were taken in the oblique, axial, and coronal planes. A radiologist examined images, and pertinent patient data were noted on a pre-drafted proforma. Histopathological and post-surgical results were acquired and documented. Results: The validity of MRI for the diagnosis of PAF was 82.4% by taking surgical findings as gold standard. Conclusion: For the assessment of PAF and the detection of abscesses, MRI is a beneficial and reliable preoperative examination

Diagnostic Features of Perianal Fistula in Patients With Crohn's Disease: Analysis of a Japanese Claims Database.

Perianal fistula (PAF) is a disabling complication of Crohn's disease (CD) which greatly impacts the quality of life. To address a scarcity of data in Asian populations, we determined the prevalence of CD-associated PAF in Japan, the order of diagnosis, and medical history of patients. A retrospective, longitudinal, observational cohort study was conducted, using an employer-based health insurance claims database. The study included patients diagnosed with CD and/or PAF from October 2013 to September 2019. The age- and gender-adjusted prevalence rates of CD-associated PAF increased from 10.33 per 100 000 in 2014, to 13.68 per 100 000 in 2019. Among patients with CD-associated PAF, 15.7% were diagnosed with PAF after diagnosis of CD, 68.6% were diagnosed with PAF before diagnosis with CD, and 15.7% were diagnosed with CD and PAF within the same month. Of the patients diagnosed with CD after PAF, approximately 30% were diagnosed with PAF by the age of 20 years, whereas less than 10% of PAF patients without CD were diagnosed with PAF by the age of 20 years. The study reveals the prevalence of CD-associated PAF in Japan and that most individuals were diagnosed with CD after the diagnosis of PAF. Crohn's disease may be underdiagnosed in patients with PAF; patients diagnosed with PAF at a young age should be monitored to allow timely diagnosis of CD.

Added value of contrast-enhanced and diffusion-weighted MRI data sets for characterization of perianal fistulas; single center experience

Aim: Our aim in this study is to determine the effectiveness of fat-suppressed T2-weighted (FS-T2W), FS-T2W+Diffusion-weighted image (DWI) and FS-T2W+Contrast-enhanced (CE) magnetic resonance imaging (MRI) data sets in the diagnosis of perianal fistula (PAF).Material and Methods: Retrospective analysis of 207 patients with a history of PAF operation between January 2018 and March 2020 was performed. The inclusion criteria were patients with PAF who underwent MRI prior to surgery and had a detailed intraoperative report. MRI data sets were evaluated by a radiologist, assessed fistula type, internal/external orifice position and presence of abscess/secondary tracts. The Cohen’s kappa (κ) statistic was used to define the level of between from intraoperative findings and MRI data sets agreement. The sensitivity and specificity were compared using the McNemar’s test.Results: All MRI data sets showed the presence of PAF correctly (n = 67, 100%). When the type of PAF per St James and AGA classification, presence of perianal abscesses/secondary tract agreement between intraoperative findings and MRI data sets is evaluated; moderate agreement for isolated FS-T2W data set, almost perfect agreement for combined FS-T2W+DWI and FS-T2W+CE data sets. In the evaluation of agreement for internal/external orifice position; substantial agreement for isolated FS-T2W data set, almost perfect agreement for combined FS-T2W+DWI and FS-T2W+CE data sets. Combined FS-T2W+DWI and FS-T2W+CE data sets have equal sensitivity and specificity each other (p = 0.544) and both data sets higher sensitivity and specificity than isolated FS-T2W data set (p 0.001, p 0.001, respectively).Conclusion: Adding DWI or CE data sets to the FS-T2W data set in the diagnosis of PAF has been shown to detect both diagnosis and complications with high accuracy. Combined FS-T2W+DWI and FS-T2W+CE data sets have equal sensitivity and specificity, and the use of the FS-T2W+DWI data set can prevent unnecessary use of contrast agent.

Role of magnetic resonance imaging in the diagnosis of perianal fistulae

Objective The aim of this study was to clarify the role of MRI in the diagnosis and classification of perianal fistula and to evaluate the additional clinical value of preoperative MRI and its benefit to the surgeon. Background An anorectal abscess originates from an infection arising in the cryptoglandular epithelium lining of the anal canal that can penetrate through the internal sphincter. Extension of the infection can involve the intersphincteric space, ischiorectal space, or even the supralevator space. Patient and methods This prospective study included 20 (15 men and five women; age range: 19–59 years; mean age: 36.85 years) patients selected from 34 patients referred to the Radiodiagnosis Department with clinically suspected perianal fistula. The study was conducted between March 2013 and November 2015 after preoperative clinical examination. Pulse sequences used were STIR, T2WI, T1WI, and T1WI after contrast with fat suppression sequences in axial, coronal, and, sometimes, sagittal planes. Results MRI revealed six (30%) patients with grade 1 simple linear intersphincteric fistula, five (25%) with grade 2 intersphincteric fistula with abscess or secondary track, three (15%) with grade 3 trans-sphincteric fistula, four (20%) with grade 4 trans-sphincteric fistula with abscess or secondary track, and two (10%) with grade 5 supralevator and translevator disease. One of the two supralevator fistulae showed horseshoe extension. MRI findings were concordant with the surgical findings in 18 (90%) patients (P = 0.003). Fallacies of MRI were observed in two (10%) patients, which proved to be sinus at surgery. Conclusion Our results support that MRI is the imaging technique of choice for preoperative evaluation of perianal fistulae, providing a highly accurate, rapid, and noninvasive means of performing presurgical assessment as it displays the anatomy of the sphincter muscles orthogonally with a background of good contrast resolution.

Evaluation of the cutting seton as a method of treatment for perianal fistula.

BACKGROUNDPerianal fistulas are distressing for the patient and sometimes a challenge for the surgeon. Different methods for the treatment of perianal fistulas have a range of success rates and use of the cutting seton is still debatable.OBJECTIVESWe evaluated the recurrence, success rate and incontinence with the cutting seton method for treating perianal fistula.DESIGNProspective, descriptive study.SETTINGAl-Hada Armed Forces Hospital, Department of General Surgery, Taif, Saudi Arabia.PATIENTS AND METHODSWe studied all patients with high perianal fistula admitted to the department of general surgery in our hospital with a diagnosis of perianal fistula in the period from December 2012 to December 2013 (12 months). Patients were followed for postoperative recurrence and incontinence rate.MAIN OUTCOME MEASURE(S)The primary outcome measured was either complete cure or recurrence.RESULTSFifty-one patients underwent cutting seton insertion for fistula in ano. The recurrence rate was 9.8%. The postoperative rate of incontinence was 15.7% to flatus and 5.9% to fluid stools. There was no incontinence to solid stools.CONCLUSIONThe cutting seton is a valid option for a complex fistula in ano, but in female patients and those with previous peri-anal surgery, other surgical options are advised.LIMITATIONSPatients with low perianal fistula, Crohn’s disease, acute perianal abscess and patients with major incontinence were excluded.

Ultrasonography Accuracy for Perianal Fistula Anatomy

Background Endorectal ultrasonography is a diagnostic modality for evaluation of perianal pathologies and suitable surgical planning, especially in perianal fistula, due to its close relation to the anal sphincter complex. Detection of anatomical location of fistula tract and abscess is critical to select the best procedure. Objectives This study tries to demonstrate the accuracy of endorectal ultrasonography in mixed group of patients in diagnosing perianal fistula during two years, retrospectively. Patients and Methods After Ethics Committee approval, all endorectal ultrasonography reports of all patients with perianal fistula referred to Shiraz Endorectal Ultrasonography Clinic of Shiraz colorectal research center between 2010 and 2012 were gathered. All endorectal ultrasonographies in this center was perform by a colorectal surgeon with BK Medical Class I type B Ultrasonography scanner with 12 MHz probe. Results Finally, 183 cases of perianal fistula were enrolled in the study. Operation notes were evaluated and the type of fistula was compared with ultrasound findings. This study showed that endorectal ultrasonography has adequate accuracy with 97.92% sensitivity and acceptable 89.53% specificity in diagnosis of perianal fistula. Compared with other reports, it seems that endorectal ultrasonography is an acceptable diagnostic tool for detecting perianal fistula compared with other diagnostic modalities. Conclusions Endoanal sonography would be one of the high sensitive modalities for evaluation of perianal fistula. Detection of anatomy of fistula helps surgeon to choose best method for surgery.

Comparison of hydrogen peroxide-enhanced ultrasound with surgery in the diagnosis of perianal fistulas

ObjetivesTo evaluate the usefulness of hydrogen peroxide-enhanced ultrasound (H2O2) in the preoperative assessment of perianal fistulas and to compare these results with unenhanced ultrasound findings. Material and MethodsAll patients with surgically confirmed perianal fistula who underwent preoperative enhanced and unenhanced ultrasound were included. We compared enhanced and unenhanced ultrasound findings with surgical results (χ2 and McNemar tests). ResultsA total of 44 surgically treated patients were analysed. Hydrogen peroxideenhanced ultrasound correctly identified primary fistula tracks in 34 patients (sensitivity of 77%), 100% of abscesses and the internal opening in 29 out of 37 identified with surgery (sensitivity of 78% and specificity of 70%). The use of hydrogen peroxide provided additional information to the ultrasound performed without the use of contrast enhancement in 32 of the 44 patients (73%). H2O2 increased the number of fistula tracts correctly detected (77% vs 45%; P<.003), particularly suprasphincteric fistulas, as well as internal openings (78% vs 22%; P<.001) and secondary tracks (70% vs 0%). Additional detection of fistula tracks after H2O2 injection was higher in patients with previous surgery (68% vs 35%; P<.05). ConclusionsHydrogen peroxide-enhanced ultrasound shows good agreement compared with surgical findings in the assessment of perianal fistulas. H2O2 improves conventional ultrasound results, increasing the detection of fistula tracks and internal openings, and also providing additional information, particularly in previously operated patients.

Perianal sonography: A simple, sensitive, feasible method for the diagnosis of perianal fistulas in crohns disease

Perianal sonography: A simple, sensitive, feasible method for the diagnosis of perianal fistulas in crohns disease

Magnetic resonance imaging with rectal Gd-DTPA: new tool for the diagnosis of perianal fistula.

This study investigated the effectiveness of magnetic resonance imaging (MRI) with rectal administration of the enteral contrast agent gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) in the diagnosis of recurrent perianal fistulae, assessing the number, anatomical extent, location, and signal intensities of various lesions. Fistulas were examined by MRI before and after rectal administration of Gd-DTPA in 50 patients (excluding fistulas due to inflammatory bowel disease). Surgical findings were compared with both pre- and postcontrast T1-weighted, T2-weighted, and short T1 inversion recovery (STIR) sequences. Of the 68 fistulous tracts detected surgically, precontrast imaging identified 16 by T1-weighted images (hypointense), 27 by T2-weighted images (hyperintense or iso- to weakly hyperintense), and 54 by STIR. Postcontrast imaging identified 29 by T1-weighted images, 58 by T2-weighted, and 54 by STIR. MRI with rectal administration of Gd-DTPA thus facilitates determination of fistula tracts, which are better resolved by precontrast STIR than by either precontrast T1- or T2-weighted images. Postcontrast T2-weighted images were substantially superior to T1-weighted. Both noncontrast STIR and postcontrast T2-weighted sequences were adequate for classifying fistulas in ano, but in complex recurrent anal fistula postcontrast T2-weighted images were more helpful.