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Abstract
Perianal Crohn's disease (CD) is a complex manifestation of CD that affects approximately 10% of patients. The spectrum of disease is quite variable, ranging from relatively mild disease to severe, aggressive manifestations that result in frequent hospitalizations, multiple surgeries, and poor quality of life. Despite significant recent advances in surgical and medical management, treatment remains challenging and frequently requires a multidisciplinary medical-surgical approach. The goal of this article is to review the current literature regarding the work-up, treatment, and future directions of therapy. Crucial features of effective management include the precise identification of manifestations, control of sepsis, limiting rectal inflammation, frequently with use of antitumor necrosis factor agents, and avoidance of extensive surgery.
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Affiliation(s)
- Jennifer L Williams
- Department of Surgery, Division of Colorectal Surgery, Emory University, GA, USA
| | - Virginia O Shaffer
- Department of Surgery, Division of Colorectal Surgery, Emory University, GA, USA
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Agarwal MD, Resnick EL, Mhuircheartaigh JN, Mortele KJ. MR Imaging of the Female Perineum. Magn Reson Imaging Clin N Am 2017; 25:435-455. [DOI: 10.1016/j.mric.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cavusoglu M, Duran S, Sözmen Cılız D, Tufan G, Hatipoglu Çetin H, Ozsoy A, Sakman B. Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 2017; 98:401-408. [DOI: 10.1016/j.diii.2016.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/22/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
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Chauhan NS, Sood D, Shukla A. Magnetic Resonance Imaging (MRI) Characterization of Perianal Fistulous Disease in a Rural Based Tertiary Hospital of North India. Pol J Radiol 2016; 81:611-617. [PMID: 28096904 PMCID: PMC5201120 DOI: 10.12659/pjr.899315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/16/2016] [Indexed: 12/18/2022] Open
Abstract
Background To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India. Material/Methods This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery. Results The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment. Conclusions MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.
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Affiliation(s)
- Narvir Singh Chauhan
- Department of Radiology, Dr. Rajendra Prasad Government Medical College - Tanda, Kangra, Himachal Pradesh, India
| | - Dinesh Sood
- Department of Radiology, Dr. Rajendra Prasad Government Medical College - Tanda, Kangra, Himachal Pradesh, India
| | - Anurag Shukla
- Department of Radiology, Dr. Rajendra Prasad Government Medical College - Tanda, Kangra, Himachal Pradesh, India
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The comparison of CT fistulography and MR imaging of perianal fistulae with surgical findings: a case-control study. Abdom Radiol (NY) 2016; 41:1474-83. [PMID: 27034072 DOI: 10.1007/s00261-016-0722-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic efficacies of CT fistulography and MRI, in the diagnostic work-up of perianal fistula patients. MATERIALS AND METHODS All 41 patients who were included in the study (36 males and 5 females, with an average age of 41 years) underwent CT fistulography and MRI examinations prior to surgery. The fistula characteristics obtained from these examinations were compared with the surgical findings. The comparative results were evaluated by means of the Kappa analysis method. RESULTS CT fistulography predicted the correct perianal fistula classification in 30 (73.1%) of the 41 patients, whereas MRI correctly defined fistula classification in 38 (92.7%) of these patients (the K values were 0.621 and 0.896, respectively; with p < 0.001). CT fistulography depicted 29 secondary extensions in 16 patients, whereas MR imaging revealed 28 secondary extensions in 15 patients. A substantial agreement was found between surgical findings and two modalities (K value was 0.789 and 0.793 for CT fistulography and MRI, respectively, with a p value < 0.001). In terms of locations of internal openings, CT fistulography was able to detect the locations in 28 patients (68.2%), whereas MRI was more successful in this aspect, with a number of 35 patients (85.3%). Granulation tissues, inflammation and edema around the fistula, abscesses, and fistular wall fibrosis were also evaluated. CONCLUSION CT fistulography and MRI have different advantages in the diagnosis of perianal fistulas. A good command of knowledge concerning the issue may be a key factor in modality decision.
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Ognibene NMG, Basile M, Di Maurizio M, Petrillo G, De Filippi C. Features and perspectives of MR enterography for pediatric Crohn disease assessment. Radiol Med 2016; 121:362-77. [PMID: 26838591 DOI: 10.1007/s11547-015-0613-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023]
Abstract
The aim of this paper is to provide indications for performing magnetic resonance enterography (MRE) in Crohn's disease (CD), the essential technical elements of MRE techniques and typical findings in patients with CD. Patients suffering from CD frequently require cross-sectional imaging. By performing MRE, it is possible to obtain results comparable to those obtained with endoscopy in terms of identifying and assessing disease activity and better than other cross-sectional imaging techniques, such as CT, in the evaluation of the fibrosis and complications of disease. The MR imaging of diffusion MR is a technique which enables medical staff to add important additional information and which may replace the use of intravenous contrast agents in the near future. Magnetic resonance enterography is an accurate tool for assessing bowel disease and the various complications associated with CD. The lack of exposure to non-ionizing radiation is an important advantage of this imaging technique, especially in the case of pediatric patients. Familiarity with common and pathognomonic imaging features of CD is essential for every clinician involved in the treatment of inflammatory bowel disease and the care of patients.
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Affiliation(s)
- Noemi Maria Giovanna Ognibene
- Radiodiagnostic and Oncological Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Massimo Basile
- Pediatric Radiology, Meyer Children's University Hospital, Florence, Italy
| | - Marco Di Maurizio
- Pediatric Radiology, Meyer Children's University Hospital, Florence, Italy
| | - Giuseppe Petrillo
- Radiodiagnostic and Oncological Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Claudio De Filippi
- Pediatric Radiology, Meyer Children's University Hospital, Florence, Italy.
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Liang C, Lu Y, Zhao B, Du Y, Wang C, Jiang W. Imaging of anal fistulas: comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol 2014; 15:712-23. [PMID: 25469082 PMCID: PMC4248626 DOI: 10.3348/kjr.2014.15.6.712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/13/2014] [Indexed: 12/18/2022] Open
Abstract
The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.
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Affiliation(s)
- Changhu Liang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021, China
| | - Yongchao Lu
- Traditional Chinese Medicine Department, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021, China
| | - Yinglin Du
- Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, Jinan 250014, China
| | - Cuiyan Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021, China
| | - Wanli Jiang
- Department of Radiology, Taishan Medical University, Taian 271000, China
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Perianal disease in pediatric Crohn disease: a review of MRI findings. Pediatr Radiol 2014; 44:1198-208; quiz 1195-7. [PMID: 25246189 DOI: 10.1007/s00247-014-3085-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/07/2014] [Accepted: 06/12/2014] [Indexed: 12/18/2022]
Abstract
Perianal complications of Crohn disease are a common occurrence in children and can result in significant morbidity when not accurately characterized prior to surgical intervention. MRI is an excellent imaging modality for the evaluation of perianal inflammatory bowel disease - allowing characterization and detailed description of perianal fistulas. MRI has many advantages over other imaging modalities for the pediatric patient. Radiologists will benefit from a sophisticated understanding of perianal anatomy, the classification of perianal fistulas, the advantages MRI offers in characterization of perianal fistulas as well as the common and incidental findings that are important in the MRI evaluation of perianal inflammatory bowel disease in children. Perianal fistulas are found at a high rate in pediatric referrals and are more commonly found in male patients.
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Hammer MR, Dillman JR, Smith EA, Al-Hawary MM. Magnetic resonance imaging of perianal and perineal crohn disease in children and adolescents. Magn Reson Imaging Clin N Am 2014; 21:813-28. [PMID: 24183527 DOI: 10.1016/j.mric.2013.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Noninvasive, nonionizing, multiparametric magnetic resonance (MR) imaging of the pelvis using a field strength of 3 T now provides a comprehensive assessment of perineal involvement in pediatric Crohn disease. MR imaging accurately evaluates inflammatory disease activity, and allows determination of the number and course of fistula tracts as well as their relationships to vital perianal structures, including the external anal sphincter, helping to guide surgical management and improve outcomes. This article provides an up-to-date review of perineal MR imaging findings of Crohn disease in the pediatric population, including fistulous disease, abscesses, and skin manifestations. Imaging technique is also discussed.
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Affiliation(s)
- Matthew R Hammer
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 East Hospital Drive, Room 3-220, Ann Arbor, MI 48109-4252, USA.
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Abstract
Perianal fistula is a clinical entity with multiple surgical treatment options. Recently, magnetic resonance imaging (MRI) has emerged as an important imaging modality in the management of perianal fistulas. It provides accurate description of the fistula within the anal canal in relation to the sphincter complex and other pelvic floor structures as well as the associated complications such as abscess. By understanding the surgical viewpoint, the appearance of perianal fistulas, associated complications, and post-treatment findings of commonly used surgical interventions can more accurately be interpreted to aid clinicians. The objective of the article is to review MRI indications and findings, radiological versus surgical classification schemes, and surgical treatment options for perianal fistulas.
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Magnetic Resonance Imaging Evaluation of Perianal Fistulas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Imaging techniques and combined medical and surgical treatment of perianal Crohn's disease. J Ultrasound 2013; 18:19-35. [PMID: 25767636 DOI: 10.1007/s40477-013-0042-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/05/2013] [Indexed: 12/13/2022] Open
Abstract
Crohn's disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohn's disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohn's disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons.
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Nagendranath C, Saravanan MN, Sridhar C, Varughese M. Peroxide-enhanced endoanal ultrasound in preoperative assessment of complex fistula-in-ano. Tech Coloproctol 2013; 18:433-8. [PMID: 24030783 DOI: 10.1007/s10151-013-1067-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/26/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND In complex fistula-in-ano, preoperative imaging can help identify secondary tracts and abscesses that can be missed, leading to recurrence. We evaluated hydrogen peroxide-enhanced endoanal ultrasound (PEEUS) in the characterization of fistula compared with standard clinical and operative assessment. METHODS Patients with complex fistula-in-ano treated between February 2008 and May 2009 at our institution were prospectively evaluated by PEEUS with recording of the preoperative clinical examination and intraoperative details of the fistula. Of the 135 patients with fistula-in-ano, 68 met the inclusion criteria for complex fistula-in-ano. Correlation of clinical findings and PEEUS to the gold standard intraoperative findings was assessed in characterizing the fistula. The percent agreement between the clinical and PEEUS findings against the gold standard was derived, and the kappa statistic for agreement was determined. RESULTS The mean age of the cohort was 42.54 ± 10.86 years. The fistula tracts were curvilinear, high, and transsphincteric in 16 (23.53%), 8 (11.76%), and 42 (61.76%) patients, respectively. Secondary tracts and associated abscess cavities were seen in 28 (33.82%) and 35 (51.47%) patients, respectively. PEEUS correlated better than clinical examination with regard to site (92.65 vs 79.41%; p < 0.001) and course (91.18 vs 77.94%; p < 0.001) of secondary tract and associated abscesses (89.71 vs 80.88%; p = 0.02). There was a trend of better correlation of PEEUS compared to clinical examination in classifying the primary tract as per Park's system (88.24 vs 79.41%; p = 0.06), but it did not reach statistical significance. PEEUS and clinical examination were comparable in correlation of the level of the primary tract (kappa: 0.86 vs 0.78; p = 0.22) and the site of internal opening (kappa: 0.97 vs 0.89; p = 0.22). The operative decision was changed in 13 (19.12%) subjects based on PEEUS findings. CONCLUSIONS PEEUS is a feasible and efficient tool in the routine preoperative assessment of complex fistula-in-ano.
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Affiliation(s)
- C Nagendranath
- Colorectal Unit, Department of Surgical Gastroenterology, Global Hospitals, Hyderabad, Andhra Pradesh, India
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Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr 2013; 57:401-12. [PMID: 23974063 DOI: 10.1097/mpg.0b013e3182a025ee] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes both Crohn disease (CD) and ulcerative colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss characterize both CD and ulcerative colitis. The incidence of IBD in the United States is 70 to 150 cases per 100,000 individuals and, as with other autoimmune diseases, is on the rise. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal disease has become a recognized entity and an important consideration in the diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as inflammation at or near the anus, including tags, fissures, fistulae, abscesses, or stenosis. The symptoms of PCD include pain, itching, bleeding, purulent discharge, and incontinence of stool. In this report, we review and discuss the etiology, diagnosis, evaluation, and treatment of PCD.
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Liang C, Jiang W, Zhao B, Zhang Y, Du Y, Lu Y. CT imaging with fistulography for perianal fistula: does it really help the surgeon? Clin Imaging 2013; 37:1069-76. [PMID: 23958432 DOI: 10.1016/j.clinimag.2013.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 02/18/2013] [Accepted: 04/12/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To prospectively evaluate the relative accuracy of computed tomography (CT) fistulography for preoperative assessment of fistula in ano. MATERIALS AND METHODS Ethical committee approval and informed consent were obtained. A total of 22 patients (15 male and 7 female, age 21-58 years) who were suspected of having fistula in ano underwent preoperative CT fistulography (CTF). The CT images of 0.6 mm were obtained respectively before and after fistulography; contrast-enhanced CT scan was also performed in 22 patients. CTF images were evaluated by two expert radiologists to assess the fistulas in the following respects: (a) the volume-rendered imaging; (b) the extensions of active inflammatory tissue; (c) the internal opening and external opening; (d) the hidden areas of tract or abscess; and (e) the deep abscess adjacent to fistula. CT findings in 18 patients were compared with surgical findings or exam under anesthesia. RESULTS The CTF findings in 18 cases were basically in accordance with the surgical findings and/or examination findings under anesthesia. Both coronal and transverse planes were useful in assessing the location and direction of tracts or abscesses. Complicated spatial information within the perianal soft tissue about the fistula with secondary ramifications or abscesses can be easily demonstrated to the surgeons. Contrast-enhanced images were useful in assessing the inflammatory lesion activity and infiltrated area. CONCLUSION CTF exquisitely depicts the perianal anatomy and shows the fistulous tracks with their associated ramifications, enables selection of the most appropriate surgical treatment, and therefore minimizes all chances of recurrence.
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Affiliation(s)
- Changhu Liang
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, Jingwu Road, Jinan 250021, P.R. China.
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de Miguel Criado J, del Salto LG, Rivas PF, del Hoyo LFA, Velasco LG, de las Vacas MIDP, Marco Sanz AG, Paradela MM, Moreno EF. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 2012; 32:175-94. [PMID: 22236900 DOI: 10.1148/rg.321115040] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Perianal fistulization is an inflammatory condition that affects the region around the anal canal, causing significant morbidity and often requiring repeated surgical treatments due to its high tendency to recur. To adopt the best surgical strategy and avoid recurrences, it is necessary to obtain precise radiologic information about the location of the fistulous track and the affected pelvic structures. Until recently, imaging techniques played a limited role in evaluation of perianal fistulas. However, magnetic resonance (MR) imaging now provides more precise information on the anatomy of the anal canal, the anal sphincter complex, and the relationships of the fistula to the pelvic floor structures and the plane of the levator ani muscle. MR imaging allows precise definition of the fistulous track and identification of secondary fistulas or abscesses. It provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. Radiologists should be familiar with the anatomic and pathologic findings of perianal fistulas and classify them using the St James's University Hospital MR imaging-based grading system.
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Affiliation(s)
- Jaime de Miguel Criado
- Department of Radiology, Central Radiodiagnostic Unit, Hospital del Henares, 28822 Coslada, Spain.
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George U, Sahota A, Rathore S. MRI in evaluation of perianal fistula. J Med Imaging Radiat Oncol 2011; 55:391-400. [PMID: 21843174 DOI: 10.1111/j.1754-9485.2011.02268.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This essay illustrates the usefulness of MRI in evaluating perianal fistulas, a common disease, notorious for recurrence if not assessed and treated adequately. MRI exquisitely depicts the perianal anatomy and shows the fistulous tracks and their associated ramifications and abscesses. It thus provides an excellent preoperative understanding of the disease, enabling selection of the most appropriate surgical treatment and therefore minimising all chances of recurrence.
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Affiliation(s)
- Uttam George
- Department of Radiodiagnosis, Christian Medical College and Hospital, Ludhiana, Punjab, India.
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Viganò C, Losco A, Caprioli F, Basilisco G. Incidence and clinical outcomes of intersphincteric abscesses diagnosed by anal ultrasonography in patients with crohn's disease. Inflamm Bowel Dis 2011; 17:2102-8. [PMID: 21910171 DOI: 10.1002/ibd.21596] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 11/02/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intersphincteric abscesses have been reported as uncommon manifestations of perianal Crohn's disease (CD) in surgical series, and may be diagnosed earlier by means of anal ultrasonography. The aim of this study was to evaluate the incidence and outcomes of intersphincteric abscess in a prospective cohort of patients with CD referred for perianal symptoms. METHODS Of the 420 patients with CD attending our outpatient clinic over a period of 5 years, 55 (31 males, mean age 38 ± 13 years) underwent anal ultrasonography because of newly developed symptoms suggesting perianal disease; a clinical evaluation and perianal examination was performed on the same day. RESULTS An intersphincteric abscess was diagnosed in 23 (42%) of the 55 patients with perianal symptoms, for a total cumulative 5-year incidence of 5% (95% confidence interval [CI]: 3%-7%). During a median follow-up period of 23 months (range 6-53), four of these patients required surgery, four developed a perianal fistula or small ischiorectal abscess not requiring surgery, and 15 experienced a benign course. The patients with a benign course had a longer duration of CD at the time of onset of the perianal symptoms. CONCLUSIONS Intersphincteric abscesses frequently cause perianal symptoms in patients with CD, and their clinical outcomes vary from rapidly progressive inflammation to a benign self-limiting course. The favorable outcome observed in some patients supports a first-line conservative approach to the condition.
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Affiliation(s)
- Chiara Viganò
- Department of Medical Sciences, University of Milan, Milan, Italy
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Ozkavukcu E, Haliloglu N, Erden A. Frequencies of perianal fistula types using two classification systems. Jpn J Radiol 2011; 29:293-300. [DOI: 10.1007/s11604-010-0556-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/21/2010] [Indexed: 12/17/2022]
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Joyce M, Veniero JC, Kiran RP. Magnetic resonance imaging in the management of anal fistula and anorectal sepsis. Clin Colon Rectal Surg 2010; 21:213-9. [PMID: 20011419 DOI: 10.1055/s-2008-1081000] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Complex perianal disease may be extremely debilitating for the patient with significant impingement on quality of life. The accurate identification of anatomical areas of involvement and subsequent appropriate management is crucial to achieving a successful outcome when treating anorectal sepsis and anal fistulae. Magnetic resonance imaging (MRI) has become a powerful tool in the evaluation of anal anatomy. In patients with complex disease MRI is an important adjunct in delineating disease location and extent, its relationship to sphincter muscles, and in planning management. MRI also plays an important role in evaluating the response to medical and surgical therapies.
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Affiliation(s)
- Myles Joyce
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Barreiros AP, Hirche TO, Ignee A, Nürnberg D, Dietrich CF. Indications and limitations of perineal ultrasound examination. Scand J Gastroenterol 2010; 45:764-5. [PMID: 20148730 DOI: 10.3109/00365521003628343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ana Paula Barreiros
- Department of Internal Medicine I, Johannes Gutenberg-University Mainz, Mainz
- Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - Tim O. Hirche
- Department of Internal Medicine I, University Hospital Frankfurt, Germany
| | - Andre Ignee
- Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - Dieter Nürnberg
- Department of Internal Medicine B, Ruppiner Kliniken, Neuruppin
| | - Christoph F. Dietrich
- Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim
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Anal endosonography and fistulography for fistula-in-ano. Radiol Med 2010; 115:771-83. [DOI: 10.1007/s11547-010-0524-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 09/17/2009] [Indexed: 02/08/2023]
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González-Lama Y, Vera MI, Calvo M, Abreu L. [Markers of the course of inflammatory bowel disease treated with immunomodulators or biological agents]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:449-60. [PMID: 20122758 DOI: 10.1016/j.gastrohep.2009.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 11/01/2009] [Indexed: 11/19/2022]
Abstract
Immunosuppressive or biological treatment in patients with inflammatory bowel disease can modify the natural history of their disease, although these treatments are not universally effective and can have severe adverse effects. Attempts have been made to identify predictive factors of response to the various therapeutic options in order to aid the choice of the most appropriate therapeutic alternative in each patient. The possibility of modifying any one of these predictive factors would be of great interest since it would provide the opportunity to alter the course of the disease. Epidemiological, biological, clinical, endoscopic, radiological, genetic and even proteomic markers have been studied, in addition to others related to the disease itself or to specific treatments. The present article briefly discusses the real use of each of these markers and the evidence supporting their utility.
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Affiliation(s)
- Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Hoeffel C, Marcus C, Arrivé L, Bouché O, Tubiana J. [Postoperative imaging after colorectal surgery]. ACTA ACUST UNITED AC 2009; 90:954-68. [PMID: 19752833 DOI: 10.1016/s0221-0363(09)73234-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgery for the treatment of colorectal diseases has been evolving rapidly recently. In addition to classical surgical procedures (colectomy, abdominoperineal resection), new surgical procedures include coloproctectomy with creation of an ileoanal anastomosis and ileal pouch, pelvic reconstructions (omentoplasty, placement of myocutaneous flaps) and creation of different colic anastomoses after anterior rectal resection. Even if computed tomography and fluoroscopic contrast examinations are still commonly used to assess postoperative changes and complications, especially infections, pelvic magnetic resonance imaging is useful to depict postoperative changes, detect complications such as fistulas and tumor recurrence in patients who have undergone surgery for primary or recurrent rectal disease. The main surgical techniques, their respective indications and postsurgical imaging features will be discussed. The main complications and imaging work-up will also be reviewed.
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Affiliation(s)
- C Hoeffel
- Pôle d'Imagerie, Service de Radiologie, CHU de Reims, Hôpital Robert-Debré, 51092 Reims, France.
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25
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Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, Varma JS, George BD. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis 2007; 9 Suppl 4:18-50. [PMID: 17880382 DOI: 10.1111/j.1463-1318.2007.01372.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- J G Williams
- McHale Centre, New Cross Hospital, Wolverhampton, UK.
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Knechtges P, Buchanan GN, Willatt J, Williams AB, Francis IR. Fistula-in-Ano: The Role of Imaging in Diagnosis and Presurgical Planning. SEMINARS IN COLON AND RECTAL SURGERY 2007. [DOI: 10.1053/j.scrs.2007.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mardini HE, Schwartz DA. Treatment of perianal fistula and abscess: Crohn’s and non-Crohn’s. ACTA ACUST UNITED AC 2007; 10:211-20. [PMID: 17547859 DOI: 10.1007/s11938-007-0014-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The management of perianal abscesses and fistulas is relatively straightforward in most cases and based on a sound knowledge of the anatomy of the anorectum and adherence to established medical and surgical principles. Asymptomatic fistulas should not be treated, whereas abscesses require surgical drainage under general anesthesia. Fistula treatment includes drainage of any associated sepsis and eradication of the fistula track to prevent recurrence while preserving sphincter integrity. A small percentage of anal abscesses and fistulas are complex and very challenging to manage, particularly in conditions such as rectovaginal fistulas and abscesses and/or fistulas complicating Crohn's disease. Treatment strategies in these situations rely on an accurate clinical assessment of the degree of rectal inflammation and perianal pathology. Treatment should combine aggressive medical therapy (antibiotics, immunomodulators, and anti-tumor necrosis factor antibody treatment) and minimal surgical interventions. Patients with proctitis have a significantly lower healing rate and a significantly higher complication rate with aggressive surgical interventions.
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Affiliation(s)
- Houssam E Mardini
- David A. Schwartz, MD Director, Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, 1501 TVC, Nashville, TN 37232, USA.
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Quel est l’apport des examens complémentaires dans la prise en charge d’une fistule anale? ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s11725-007-0025-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Schmidt S, Chevallier P, Bessoud B, Meuwly JY, Felley C, Meuli R, Schnyder P, Denys A. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol 2007; 17:2957-63. [PMID: 17492288 DOI: 10.1007/s00330-007-0669-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 02/27/2007] [Accepted: 04/19/2007] [Indexed: 01/01/2023]
Abstract
The diagnostic performance of magnetic resonance imaging (MRI) for detection of intestinal fistulas, other than perianal, in patients with known complicated inflammatory bowel conditions (CIBC) was investigated. Our study group consisted of 20 patients (12 women, mean age 43 years) with CIBC, including Crohn's disease (n=13), colonic diverticulitis (n=3), colitis after radiotherapy (n=3) and of postoperative origin (n=1). Eleven surgically proven enteral fistulas were known in ten (50%) of these patients, being of enterovesical (n=3), enterocolic (n=2), enteroenteral (n=2), rectovaginal (n=2), rectovaginovesical (n=1) and of entercutaneous (n=1) localisation. The other ten patients (50%), used as the control group, showed MR features of CIBC, although without any fistulous tract. Multiplanar T1- and T2-weighted sequences had been performed, including gadolinium-enhanced acquisition with fat saturation (1.5 T). MR findings were independently blindly and retrospectively reviewed by three radiologists for the presence and etiology of any fistula, as well as visualization and characterization of the fistulous tract. Results were compared with surgical findings (n=16) and clinical evolution (n=4). Interobserver agreement was calculated. Interobserver agreement kappa for fistula detection was 0.71. Overall sensitivity, specificity and accuracy for fistula detection were 78.6%, 75% and 77.2%, respectively. Sensitivity for fistula characterization was 80.6%, with visualization of the fistulous tract in all cases, whereby T1-weighted gadolinium-enhanced fat-saturated images were considered the most useful sequences. Gadolinium-enhanced MRI is a reliable and reproducible tool for detection of enteral fistulas secondary to inflammatory conditions.
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Affiliation(s)
- S Schmidt
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier, Universitaire Vaudois-CHUV, Rue du Bugnon, 1011, Lausanne, Switzerland.
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Essary B, Kim J, Anupindi S, Katz JA, Nimkin K. Pelvic MRI in children with Crohn disease and suspected perianal involvement. Pediatr Radiol 2007; 37:201-8. [PMID: 17180366 DOI: 10.1007/s00247-006-0372-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 10/30/2006] [Accepted: 11/09/2006] [Indexed: 02/06/2023]
Abstract
MRI is an important imaging tool in evaluation of adult and pediatric patients with Crohn disease. Pelvic MRI, in particular, has become the method of choice to evaluate for perianal fistulas and associated complications of Crohn disease. MRI can define the extent and location of perianal fistulas and abscesses, as well as provide critical information for operative management. In this pictorial essay, we describe useful MRI techniques for evaluation of perianal complications in pediatric patients with Crohn disease. We review pertinent anatomy and illustrate typical examples of perianal fistulas with and without abscess. We show one case of clinically suspected perianal fistula that was actually a pilonidal sinus.
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Affiliation(s)
- Brendan Essary
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Affiliation(s)
- V Datta
- Department of Surgery, University College London Hospitals, London NW1 2BU
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Hoeffel C, Arrivé L, Mourra N, Azizi L, Lewin M, Tubiana JM. Anatomic and pathologic findings at external phased-array pelvic MR imaging after surgery for anorectal disease. Radiographics 2006; 26:1391-407. [PMID: 16973771 DOI: 10.1148/rg.265055723] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pelvic magnetic resonance (MR) imaging is useful for identification of postoperative changes, complications, and disease recurrence in patients who have undergone surgery for primary or recurrent anorectal disease. Commonly used interventions include treatment for anorectal carcinoma: anterior rectal resection with or without creation of different colic anastomoses and abdominoperineal excision with or without pelvic reconstruction (omentoplasty, placement of myocutaneous flaps). Other common interventions include treatment for inflammatory bowel disease (coloproctectomy with or without creation of an ileoanal anastomosis and ileal pouch) and treatment for fistulas (placement of flaps or setons). Postoperative anatomic changes and formation of scar tissue can usually be identified with consecutive MR imaging examinations. Pelvic MR imaging is an accurate technique for assessment of complications including anastomotic leakage, septic complications such as fistulas and abscesses, neoplastic recurrence, and other less common complications (perineal hernia, peritoneal pseudocyst). The sophisticated surgical procedures used in rectal surgery can alter normal anatomy and make image interpretation difficult. Thus, familiarity with the appearances of postoperative anatomic changes, complications, and tumor recurrence is essential for accurate MR imaging evaluation after surgery for anorectal disease.
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Affiliation(s)
- Christine Hoeffel
- Department of Radiology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France.
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Caprioli F, Losco A, Viganò C, Conte D, Biondetti P, Forzenigo LV, Basilisco G. Computer-assisted evaluation of perianal fistula activity by means of anal ultrasound in patients with Crohn's disease. Am J Gastroenterol 2006; 101:1551-8. [PMID: 16863560 DOI: 10.1111/j.1572-0241.2006.00561.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Assessment of the activity of perianal fistulas may be of clinical relevance in patients with Crohn's disease. Fistula activity is currently evaluated by means of magnetic resonance imaging; anal ultrasound can also be used, but its diagnostic performance in this setting remains to be defined. Our aims were to evaluate the agreement between clinical examination, magnetic resonance imaging, and anal ultrasound in assessing perianal fistula activity, and to apply computerized analysis to improve the assessment of ultrasound images. METHODS Thirty-one consecutive patients with Crohn's perianal fistulas underwent clinical examination, and magnetic resonance and anal ultrasound imaging. Active fistulas were defined as the presence of active drainage or signs of local inflammation on clinical examination, and the definition was confirmed by surgical examination. Activity was assessed on the basis of T2 hyperintensity on magnetic resonance imaging and the degree of hypoechogenicity on anal ultrasound; the anal ultrasound images were also analyzed using dedicated computer image-analysis software. RESULTS Twenty-five patients had an active fistula at clinical examination. The agreement between clinical examination and magnetic resonance imaging was good (k-value = 0.739), whereas that with anal ultrasound was only fair (k-value = 0.266-0.294); computer-assisted analysis of the anal ultrasound images improved the agreement from fair to good (k-value = 0.608-0.670). CONCLUSIONS Anal ultrasound can be used to assess fistula track activity in patients with Crohn's disease. The diagnostic performance of the technique can be improved to values comparable with those of magnetic resonance imaging by using a computer-assisted evaluation of the anal ultrasound images.
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Affiliation(s)
- Flavio Caprioli
- Post-graduate School of Gastroenterology and Digestive Endoscopy (I), University of Milan, Milan, Italy
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Abstract
Technological developments have extended the role of MRI in the evaluation of the gastrointestinal tract. The potential of MRI to evaluate disease activity in Crohn's disease has been investigated extensively, as MRI has intrinsic advantages over other techniques, including noninvasiveness and the absence of ionizing radiation. For perianal fistulizing disease MRI has become a mainstay in evaluation of disease, as localization and extent of disease can be very well appreciated using both T2-weighted and T1-weighted sequences, fat suppression, and intravenous contrast medium. Imaging of the small bowel and colon in Crohn's disease is more complicated due to bowel peristalsis and respiratory movement. However, using fast breathhold sequences and intravenous spasmolytic medication, images of good diagnostic quality can be acquired. To obtain sufficiently distended bowel, which in our estimation is a prerequisite for evaluation of the bowel, MR enteroclysis can be performed. However, applicability of different oral contrast media has been studied, as a noninvasive method for bowel distension would be preferable. Abdominal MRI is a valuable imaging technique for evaluation of luminal, transmural, and extraintestinal manifestations of Crohn's disease as degree of disease activity, presence of luminal pathology (e.g., stenoses), and extraintestinal manifestations of disease (e.g., abscesses, fistulas) can be accurately assessed.
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Affiliation(s)
- Karin Horsthuis
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
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Abstract
Anal abscesses and fistulas are a common part of surgical practice. Most abscesses simply need to be drained and most fistulas can be safely laid open. Excessive probing should not be attempted when draining abscesses as this may lead to iatrogenic fistulas. A small percentage of fistulas are complex and very challenging to manage. Management involves an accurate diagnosis and a balance between eradication of the fistula and maintenance of continence. A decision should be made, based on clinical evaluation and anal ultrasound (if available), whether the fistula can be laid open. If it cannot be laid open, a loose seton is placed and the sepsis is allowed to settle. Once the sepsis is quiescent, a definitive repair can be attempted. There are various techniques available including rectal advancement flap, fibrin glue and cutaneous flaps all of which are discussed.
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Affiliation(s)
- Matthew J F X Rickard
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales 2137, Australia.
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Szyszko TA, Bush J, Gishen P, Sellu D, Desouza NM. Endoanal magnetic resonance imaging of fistula-in-ano: a comparison of STIR with gadolinium-enhanced techniques. Acta Radiol 2005; 46:3-8. [PMID: 15841733 DOI: 10.1080/02841850510015947] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare a STIR sequence with gadolinium-enhanced techniques on endoanal magnetic resonance (MR) imaging of fistulas-in-ano by correlating the findings with those at surgery. MATERIAL AND METHODS Twenty-two consecutive patients with clinical suspicion of perianal sepsis were studied using an endoanal coil followed immediately by a phased array coil. T1-weighted precontrast and postcontrast and STIR images in transverse and coronal planes were produced with each coil and analysed by noting the presence and site of a collection, primary track, the position of any internal opening, and subcutaneous or supralevator extension. An "expert" and also a "trainee" radiologist assessed the images. Operative findings were similarly recorded. The Fisher exact test was used to compare imaging with surgery. Interobserver variation was calculated using a kappa statistic. RESULTS Of 22 patients with suspected fistulas, 8 were simple, 4 were complex, and 3 were superficial sinuses. Five had no anal pathology, 1 had anal excoriation, and 1 had a polyp. At surgery, 6 intersphincteric, 1 transsphincteric, 8 extrasphincteric, no supralevator collections, and 9 internal openings were noted. The overall sensitivity and specificity for detecting these were 75% and 64%, respectively, for STIR imaging, and 58.3% and 62.8% for gadolinium-enhanced imaging. There was good agreement between the "trainee" and the "expert" in the interpretation of images (kappa=0.7). CONCLUSION A STIR sequence is more sensitive overall than gadolinium-enhanced techniques on endoanal magnetic resonance imaging of fistulas-in-ano because of increased sensitivity in detecting the internal opening. A combination of endoanal and phased array techniques using STIR imaging sequences is valuable preoperative assessment in both simple and complex cases.
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Affiliation(s)
- T A Szyszko
- Department of Imaging, Hammersmith Hospitals NHS Trust, London, UK.
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Abstract
Endorectal (ERUS) and endoanal (EAUS) ultrasound imaging is increasingly being performed by surgeons in the office and outpatient setting for the assessment of both benign and malignant disease. Multiple studies have demonstrated the accuracy of these modalities in identifying pertinent anatomy and anatomic abnormalities. The ultrasound is easily tolerated by most patients, and is easily performed with minimal preparation on the patient's part. The ability of the surgeon to perform and interpret this straight forward diagnostic procedure allows for the simplification of the diagnostic process and a more rapid determination of treatment options for the patient.
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Affiliation(s)
- David M Schaffzin
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C1083, New York, NY 10021, USA
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Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis 2004; 10:45-54. [PMID: 15058527 DOI: 10.1097/00054725-200401000-00008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiologic imaging--especially of the small bowel--plays an important role in the diagnosis and management of patients with inflammatory bowel disease. The radiographic examination of the small intestine with barium either as enteroclysis or as small bowel follow through are still the mainstays in small bowel imaging. However, abdominal CT or MRI, which has the advantage of not utilizing ionizing radiation, or the techniques of CT- or MR-enteroclysis, are overall comparable with regard to the sensitivity and specificity in detecting intestinal pathologies and have already replaced the conventional techniques in centers dedicated to the management of inflammatory bowel disease. Additionally, these cross-sectional imaging techniques provide, in a sense, a "one stop abdominal imaging workup," the diagnosis of extraluminal disease manifestations or complications. Future developments of CT- or MR-based virtual colonography and endoscopy in patients with inflammatory bowel disease are currently being investigated, but should momentarily be considered as purely experimental approaches.
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