Role of Transcutaneous Perianal Ultrasonography in Evaluation of Perianal Fistulae with MRI Correlation

Abstract

Purpose: The aim of this study was to evaluate the role of transcutaneous perianal ultrasonography (TPUS) in patients with perianal fistula and to correlate the findings with magnetic resonance imaging (MRI) as gold standard. Materials and Methods: This prospective study included patients who presented with suspicion of perianal fistula. After clinical examination, TPUS and MRI of perianal region were performed on each of them. Clockwise position of internal opening of the fistula was described. The entire length of the tract was evaluated up to the external opening. Also, any ramifications along the primary tract were described. Parks et al and St James's University Hospital MR Imaging Classification of Perianal Fistulas were used for classifying the fistulas. Results: Out of total 37 patients, the most common age group of presenting individuals was 45 to 60 years with male to female ratio of 6.4:1. There was excellent agreement between TPUS and MRI for detecting primary fistulous tract with kappa correlation coefficient of 1. The kappa correlation coefficient for detecting secondary fistulous tracts and abscess on TPUS and MRI was 0.839 and 0.937 showing excellent agreement. Moderate agreement was seen with kappa correlation coefficient of 0.839 in the detection of internal opening on TPUS and MRI. Conclusion: TPUS showed promising results in diagnosis and classification of perianal fistulae with MRI as gold standard. A wide availability, cost-effectiveness, and better tolerability of TPUS can make it an imaging modality of first choice for evaluating perianal fistulae.

Laporan Kasus Infeksi/Inflamasi Traktus Gastrointestinal Bawah Abses Perianal Dengan Fistula

“…Berdasarkan kepustakaan, modalitas pertama yang dapat digunakan dalam mengevaluasi abses dan fistula perianal adalah USG. (10,11) USG sendiri memiliki sensitivitas yang kurang lebih sama dengan MRI dalam mendiagnosis abses dan fistula perianal. (11) Metode USG yang dapat digunakan adalah endoanal (EAUS), transvaginal (TVUS) ataupun transperineal (TPUS).…”

“…(10,11) USG sendiri memiliki sensitivitas yang kurang lebih sama dengan MRI dalam mendiagnosis abses dan fistula perianal. (11) Metode USG yang dapat digunakan adalah endoanal (EAUS), transvaginal (TVUS) ataupun transperineal (TPUS). (10,11) Kombinasi dari EAUS dan MRI memiliki akurasi diagnostik mencapai 100% dalam evaluasi abses dan fistula perianal.…”

Surgical treatment of anal fistula

“…Появление новых технологий дооперационной топографической верификации свищей прямой кишки предопределило появление классификации Университетской больницы Сент-Джеймса (St. James's University Hospital, SJUH) [25]. Попытка унифицированного хирургического подхода к лечению SIBERIAN SCIENTIFIC MEDICAL JOURNAL 2023; 43 (5): 74−84 больных с криптогландулярными свищами хорошо определена в руководстве Американского общества колоректальных хирургов, которое делит анальные свищи на «простые» и «сложные»; последняя категория указывает на повышенный риск недержания после операции [26,27]. Целевая группа по стандартной практике (Standard Practice Task Force, SPTF) также подразделяет анальные свищи на простые и сложные.…”

Incidence and diagnostic performance of ultrasound for perianal abscess or fistula‐in‐ano in pediatric patients with perianal inflammation

“…Perianal inflammation, including perianal abscess and fistula‐in‐ano, is a common complication in children resulting from cryptitis‐caused bacterial entrapment at a thickened dentate line; further, it can progress to perianal abscess with or without healing and develop into a fistula‐in‐ano 1–6 . Physical examination as well as imaging examinations such as ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) can be used to detect and diagnose perianal abscess and fistula‐in‐ano 2–6 . Among these examinations, ultrasound allows the evaluation of pediatric patients since it can be rapidly performed at the patient's bedside without sedation or radiation exposure.…”