The contribution of preoperative MRI to the surgical management of anal fistulas

Konan, Ali; Onur, Mehmet Ruhi; Özmen, Mustafa

doi:10.5152/dir.2018.18340

Cited by 39 publications

(28 citation statements)

References 30 publications

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“…Recently, MRI has been considered the ‘gold standard’ technique for the preoperative evaluation of fistula-in-ano. An accurate and comprehensive assessment to detect primary tracks, associated ramifications and abscesses plays a crucial role in determining surgical outcomes and minimising complications, such as faecal incontinence, as well as recurrent lesions 1,10–12 .…”

Section: Introductionmentioning

confidence: 99%

The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas

Phan

Nguyen

et al. 2019

Sci Rep

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This study aimed to determine the role of magnetic resonance imaging (MRI) in diagnosing and describing the characteristics of fistula-in-ano, and the agreement between MRI and operative findings. We conducted a retrospective study in 367 patients with fistula-in-ano who were diagnosed and had an operation at the University Medical Center between January 2016 and January 2018. MRI findings were evaluated and compared with surgical findings using the kappa coefficient (k) method. 367 patients (327 male and 40 female, mean age 39.3 ± 12.4 years). A total of 411 primary fistulas were found during surgery. There was a strong agreement between MRI and surgery for classifying primary tracts (k = 0.89) and detecting secondary tracts (k = 0.94). While the sensitivity and specificity of MRI for detecting internal openings were 99% and 85.2% respectively; these rates were 100% for abscesses. Both T2-weighted turbo spin-echo (T2W TSE) and postcontrast fat-saturated T1-weighted turbo spin-echo (FS T1W TSE) sequences showed high sensitivity (96.6% and 98.4% respectively) and specificity (92.6% and 81.5% respectively) for depicting internal openings and secondary tracts. Post-contrast FS T1W TSE sequence was very effective in detecting abscesses with an accuracy of 100%. In conclusion, MRI can be considered an accurate tool for the preoperative evaluation of fistula-in-ano, which is a major determinant of the surgical outcome. Both T2W TSE and post-contrast FS T1W TSE sequences are highly accurate in depicting the features of fistula-in-ano. If there are no contraindications, contrast administration is recommended to differentiate abscesses from active inflammation.

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Section: Introductionmentioning

confidence: 99%

The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas

Phan

Nguyen

et al. 2019

Sci Rep

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“…Deep perianal abscesses are often diagnosed not by inspection but by palpation. In addition, superficial perianal abscesses can be diagnosed by visual inspection 1,2 . However, in our case, the abscess was relatively superficial in the perianal area with the shape of a soft tumor, similar to that of a lipoma.…”

Section: Figurementioning

confidence: 62%

Superficial anorectal abscess resembling a lipoma: A case report

Kogo

Takasaki

Sakata

et al. 2020

Clinical Case Reports

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Perianal abscesses exist in various forms depending on the location. In the present case, lipoma-like abscess was observed. A 34-year-old Japanese man with no relevant medical history presented to our outpatient clinic with the chief complaint of anal pain. On examination, he was found to have a soft perianal tumor that resembled a lipoma (Figure 1). We decided to perform surgical resection under spinal saddle block anesthesia in the lithotomy position. Operative findings and examination of the resected specimen revealed that

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“…At present, with the continuous development of imaging technology, research has confirmed that MRI can accurately display the specific location and number of fistula, which provides a favorable reference value for surgery [10,11,20,21]. MRI is now the gold standard for the diagnosis of anal fistula and perianal sepsis, but a large number of patients with perianal sepsis often have not been subjected to this test at an earlier time [12].…”

Section: Discussionmentioning

confidence: 99%

Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors

et al. 2020

BMC Surg

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Background: The choice of surgery for perianal sepsis is currently controversial. Some people advocate one-time radical surgery for perianal sepsis, while others advocate incision and drainage. The objective of this study is to observe the formation probability of secondary anal fistula after incision and drainage in patients with perianal sepsis and determine factors that contribute to secondary anal fistula after incision and drainage. Methods: A retrospective descriptive analysis was conducted in 288 patients with perianal sepsis who were treated with anorectal surgery in the Suzhou Hospital of Traditional Chinese Medicine from January 2016 to June 2018. The patients were followed by telephone, physical examination, and pelvic MRI examination for at least 1 year after surgery. Results: Three patients were not followed, 98 patients did not receive surgical treatment or one-time radical surgery for perianal sepsis, and 187 patients were ultimately identified for the study. Anal fistula was present in 105 patients, and the rate of formation of secondary anal fistula was 56.15%. There was no statistically significant difference in the fistula formation rate between different types of sepsis (P>0.05). And, in patients with secondary anal fistula, there was no significant correlation between the location of sepsis and the type of secondary anal fistula (P>0.05). Conclusions: The incidence of secondary anal fistula after incision and drainage of perianal sepsis is 56.15%, which is lower than the incidence found in previous study. Young is a risk factor for secondary anal fistula after incision and drainage of perianal sepsis. There is no significant correlation between the location of sepsis and the type of secondary anal fistula. Simple incision and drainage is a suitable choice for patients with acute perianal sepsis.

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The contribution of preoperative MRI to the surgical management of anal fistulas

Cited by 39 publications

References 30 publications

The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas

The role of magnetic resonance imaging in the preoperative evaluation of anal fistulas

Superficial anorectal abscess resembling a lipoma: A case report

Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors

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