MR fistulography with percutaneous instillation of aqueous jelly: A cost effective technique innovation

Abstract

Background:Perianal fistula is a commonly encountered condition in routine surgical practice. Accurate presurgical mapping of these tracts is vital to prevent recurrence. We have assessed the effectiveness of percutaneous instillation of aqueous jelly prior to magnetic resonance (MR) fistulography.Aims and Objectives:To study the role of percutaneous instillation of aqueous jelly in fistulous tracts prior to MR fistulography.Materials and Methods:All patients with active discharge, referred for MR fistulography between January 2014 and April 2016, were included in this study. Approximately 3–5 ml of sterile aqueous jelly was percutaneously instilled into the external openings prior to MR fistulography. Post MR fistulography, patients were monitored till surgery for pain, fever, or bleeding. The type of fistulae, location of internal openings, lateral ramifications, and presence of abscess were compared with per operative findings for diagnostic accuracy.Results:Sixty-four patients enrolled in our study had undergone preoperative MR fistulography with aqueous jelly instillation. MR fistulography revealed a total of 77 tracts and showed a sensitivity and specificity of 100% in delineation of type of tract. Forty-nine internal openings were identified with 94.2% sensitivity, 100% specificity, and 95.3% accuracy. 90.5% sensitivity, 100% specificity, and accuracy of 97% were observed in delineation of lateral ramifications. None of the patients reported pain, fever, or bleeding post procedure till surgery.Conclusion:Percutaneous instillation of aqueous jelly prior to MR fistulography is a safe, cost effective, and accurate technique to provide a comprehensive delineation of the complex anatomy of perianal fistulae.

Magnetic Resonance Imaging of Perianal Fistulas in Clinically Symptomatic Patients and the Correlation Among Plain, Contrast, and Post Jelly MRI Fistulography

“…Aggarwal et al performed percutaneous instillation of aqueous jelly into the perianal fistulas in 64 subjects and the postjelly MR fistulography findings were compared with the surgical results, which showed a sensitivity of 97% and positive predictive value of 100% in comparison with peroperative findings. 13 Waniczek et al performed an MRI after injecting a few drops of gadolinium mixed with saline through the external fistulous opening in 14 subjects, and the surgical findings were consistent with radiological descriptions of 13 MRI fistulographies. 9 Likewise, in our study, it was possible to diagnose the type of tract and compare it with the plain MRI findings in all 29 patients postjelly injection,.…”

Comparative study of percutaneous (perianal) instillation of aqueous jelly & percutaneous (perianal) gadolinium instillation in MR fistulography with its surgical correlation

“…Contrast enhanced FS T1 imaging sequence can better identify the primary fistulous tract, internal openings, lateral ramifications, as well as improves visualization of the smaller tracts. [1] Gadolinium shortens the T1 time and hence makes the walls of the fistulae more evident (Figure 6). With gadolinium, the chronic tracts & scar tissue may not show any enhancement.…”

“…Aqueous jelly has a long T2 relaxation time; giving it an intrinsic contrast (Figure 8) on T2 weighted imaging. [1] Since, it is an easy procedure; it can be done on a regular basis for better outcome. Our study demonstrated similar findings with both the methods of contrast administration that were studied with the percutaneous instillation of gadolinium (Figure 9) showing marginally better results with the identification of secondary tracts.…”

“…The main modality of treatment is surgery. [1] Improper excision can cause frequent recurrences and sphincter muscle damage during surgery which can lead to incontinence later. Hence a detailed and proper technique is required prior to surgery in improving the outcome.…”

“…Aqueous jelly has a long T2 relaxation time, giving it an intrinsic contrast on T2 weighted imaging. [1] With percutaneous gadolinium instillation, the active fistulous tracts enhance well which helps in better delineation of the tract. [3] In this study, we conducted a comparative study of the accuracy of MR fistulography with percutaneous (perianal) instillation of aqueous jelly as well as percutaneous (perianal) instillation of gadolinium with surgical correlation of the intra-operative findings.…”