Pre-Operative MRI in evaluation of Perianal fistulas

Background: Perianal fistula is a common and often an extremely distressing disorder. MRI is a preferred modality for the preoperative assessment of perianal fistulas. Aims and Objective: To evaluate the accuracy and predictive values of pre-operative MRI in diagnosing severity of perianal fistulas and the conditions associated with it like internal anal opening, secondary tract, abscess and supralevator extension. Materials and Methods: In this study, 44 patients with clinically suspected perianal fistulas underwent MRI for the evaluation of severity and presence of the associated conditions. St James’s University Hospital Classification was used to grade the perianal fistula. Pre-operative MRI grading was compared with the surgical findings in the 26 operated patients. Results: Out of 44 clinically suspected perianal fistulas, 41 (93%) were diagnosed as perianal fistulas by MRI. The most common type was grade 1 seen in 12(27.3%) patients followed by grade 4 fistula seen in 10(22.7%) patients. All 26 patients evaluated by surgical findings for severity of perianal fistulas were found to be graded in identical grades by pre-operative MRI. MRI was 100% sensitive in picking up all five grades. Conclusion: MRI helps in the accurate delineation of fistulous tract, identification of secondary tract and abscess.

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Role of MRI in the Diagnosis and Pre-Operative Classification of Perianal and Anal Fistulas - A Cross-Sectional Study, Southern Rajasthan

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/574 ◽

2021 ◽

Vol 8 (33) ◽

pp. 3156-3162

Author(s):

Hari Ram Jat ◽

Neel Patel ◽

Sitaram Barath ◽

Pooja Yadav

Keyword(s):

Perianal Fistula ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Anal Fistulas ◽

Chi Square ◽

Cross Sectional ◽

Perianal Fistulas ◽

Operative Assessment

BACKGROUND Perianal fistulas account for a substantial discomfort and morbidity to the patient thus affecting productive man hours and quality of life. Accurate pre-operative assessment of course of the primary fistulous track and secondary extension or abscesses is required for successful surgical management of anal fistulas. The purpose of this study was to diagnose and classify pre-operative perianal fistulas. METHODS This is a cross-sectional study at Department of Radiodiagnosis in a tertiary level hospital of southern Rajasthan from November 2018 to November 2020. The study included a total of 50 patients referred to department of radiology for magnetic resonance imaging (MRI). Statistical analysis was done using chi square test and student t test. RESULTS Out of these patients, 56 % were having secondary tract on MRI, 12 % patients were having abscess and 4 % were having horseshoe abscess on MRI. The commonest type of ano-rectal fistula encountered in the study was Grade -II seen in 32 %. CONCLUSIONS MRI is a highly accurate, rapid and non-invasive tool in pre-operative evaluation of the perianal and anal fistulas. MRI evaluation and classification of perianal fistulae has a high degree of diagnostic accuracy. The use of MRI for the diagnosis and classification of perianal fistula can provide reliable information which has both pre-operative and prognostic value. St James University Hospital classification, which is an MR imaging-based grading system for perianal fistula is very useful for effective radiological-surgical communication thus contributing to improved patient care and reduced rate of recurrence. KEYWORDS MR Fistulogram, Perianal Fistula, Anal Fistula, Fistula Classification, Fistulography

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Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View

Annals of Coloproctology ◽

10.3393/ac.2021.02.08 ◽

2021 ◽

Vol 37 (1) ◽

pp. 5-15

Author(s):

Jong Lyul Lee ◽

Yong Sik Yoon ◽

Chang Sik Yu

Keyword(s):

Surgical Management ◽

Crohn Disease ◽

Management Strategy ◽

Fistulous Tract ◽

Perianal Fistula ◽

Current Standard ◽

Necrosis Factor Alpha ◽

Perianal Fistulas ◽

Stoma Creation

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

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Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula

Journal of Coloproctology ◽

10.1055/s-0041-1735545 ◽

2021 ◽

Vol 41 (03) ◽

pp. 217-221

Author(s):

Yasser A. Orban ◽

Hossam Hassan Soliman ◽

Ahmed M. El Teliti ◽

Ali El-Shewy ◽

Yasmine Hany Hegab ◽

...

Keyword(s):

Fistulous Tract ◽

Perianal Fistula ◽

Complete Healing ◽

University Hospital ◽

Direct Access ◽

Fistula Tract ◽

Recurrence Rates ◽

Fistula Treatment ◽

High Perianal Fistula ◽

Sphincteric Reconstruction

Abstract Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

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3T MR imaging evaluation of perianal fistulas: an initial experience in Nepal

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v19i1.24552 ◽

2016 ◽

Vol 19 (1) ◽

pp. 25-30

Author(s):

Ghanshyam Gurung

Keyword(s):

Mr Imaging ◽

Fistulous Tract ◽

Tissue Differentiation ◽

University Hospital ◽

Invasive Technique ◽

Internal Opening ◽

Female Ratio ◽

Perianal Fistulas ◽

Sphincter Complex ◽

3T Mr

Introduction: Fistula–in–ano is an abnormal perianal tract that connects anal canal to the perianal skin. Improper visualization of primary fistulous tract and the associated abscesses or secondary tracts a r e the causes of recurrence. Earlier imaging modalities like conventional fistulography, endosonography and CT scan have had limited role. Even without endorectal coils, 3T MRI has multi-planar imaging capability and excellent soft tissue differentiation to show perianal anatomy, primary and secondary tracts with associated abscesses in relation to sphincter complex. It provides excellent road map to surgeons for preoperative evaluation. The objective of the study was to evaluate the role of 3T MR in imaging of perianal fistulas. Methods: A retrospective study was done among 32 patients who were referred for MR fistulogram for suspected perianal fistula at Jeebanta Advanced Kathmandu Imaging, Durbar Marg, Kathmandu, Nepal. All images and findings were obtained and recorded with the help of Philips Ingenia 3T digital broadband MR scanner. Imaging was performed in oblique coronal and oblique axial plane. MR images were studied and grading system was applied according to the St James’s University Hospital Classification. The data were entered in a performa and was analyzed using IBM SPSS V21. Results: Male to female ratio was 7:1. According to St. James University Hospital MR Imaging classification of perianal fistulas, most of the patients (25%) had Grade 4 followed by (12.5% each) Grade 0, Grade 1 and Grade 2 and (6.3% each) Grade 3 and Grade 5 fistulas. Mean age was 37.28 years (Std. deviation 11.9). Common internal opening in axial image was found at 5 0’ clock positions (31.3%). Mean length of the fistulous tract was 3.9 cm (Std. deviation 2.3). Conclusion: Perianal fistulas are more common in males and Grade 4 fistulas are the commonest. MRI is well-tolerated, painless and non-invasive technique and has multiplanar capabilities with excellent tissue differentiation of pelvic muscle along with sphincter complex.

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Gas-filled urachal abscess with a pinging sound in a heifer calf

Veterinární Medicína ◽

10.17221/61/2019-vetmed ◽

2019 ◽

Vol 64 (No. 8) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

R Sato ◽

K Yamada ◽

Y Shinozuka ◽

H Ochiai ◽

K Onda

Keyword(s):

Fistulous Tract ◽

Failure To Thrive ◽

Abdominal Distension ◽

Intravenous Urography ◽

University Hospital ◽

Growth Depression ◽

Poor Growth ◽

History Of ◽

Heifer Calf ◽

Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

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Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Sao Paulo Medical Journal ◽

10.1590/s1516-31802007000600007 ◽

2007 ◽

Vol 125 (6) ◽

pp. 338-342 ◽

Cited By ~ 7

Author(s):

Camila Toffoli Ribeiro ◽

Júlio César Rosa-e-Silva ◽

Marcos Felipe Silva-de-Sá ◽

Ana Carolina Japur de Sá Rosa-e-Silva ◽

Omero Benedicto Poli Neto ◽

...

Keyword(s):

Endometrial Thickness ◽

Standard Procedure ◽

University Hospital ◽

Histopathological Analysis ◽

Benign Lesions ◽

Predictive Values ◽

Asymptomatic Patients ◽

Cavity Design ◽

Diagnostic Hysteroscopy ◽

Sensitivity Specificity

CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

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The diagnosis of delirium in 80 emergency unit patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1998000200002 ◽

1998 ◽

Vol 56 (2) ◽

pp. 176-183

Author(s):

AFONSO CARLOS NEVES ◽

RICARDO DE CASTRO CINTRA SESSO ◽

HENRIQUE BALLALAI FERRAZ ◽

SÍLVIO FRANCISCO ◽

JOÃO BAPTISTA DOS REIS-FILHO

Keyword(s):

Correct Diagnosis ◽

Diagnostic Testing ◽

Final Diagnosis ◽

Initial Diagnosis ◽

University Hospital ◽

Emergency Unit ◽

Predictive Values ◽

Kappa Test ◽

History Of ◽

Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

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Thyroglossal Duct Carcinoma with Concurrent Papillary Thyroid Carcinoma: A Case Report

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v35i1.1287 ◽

2020 ◽

Vol 35 (1) ◽

pp. 63-65

Author(s):

Anna Claudine Lahoz ◽

Precious Eunice Grullo ◽

Ryner Jose Carrillo

Keyword(s):

Case Report ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Preoperative Assessment ◽

University Hospital ◽

Papillary Thyroid ◽

Duct Cyst ◽

Duct Carcinoma ◽

Thyroglossal Duct ◽

Thyroglossal Duct Carcinoma

ABSTRACT Objective: To report a case of thyroglossal duct carcinoma with concurrent papillary thyroid carcinoma Methods: Design: Case Report Setting: Tertiary National University Hospital Patient: One Results: A 46-year-old woman was diagnosed with thyroglossal duct carcinoma after undergoing a Sistrunk procedure. Due to presence of thyroid nodules, the patient underwent second stage thyroidectomy with central neck dissection which revealed papillary thyroid carcinoma. Conclusion: Thyroglossal duct carcinomas are rare entities and there is no current consensus regarding their management. Difficulties arise in the diagnosis of these tumors as they present similarly to benign thyroglossal duct cysts. Most cases are diagnosed postoperatively. Proper preoperative assessment including head and neck examination, biopsy, and radiologic imaging is necessary to recognize patients who could benefit from more aggressive management. Keywords: thyroglossal carcinoma; thyroglossal duct cyst; papillary thyroid carcinoma

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Homeopathic treatment of perianal fistula in a dog - Case Report / Tratamento homeopático da fístula perianal num cão - Relato de caso

Brazilian Journal of Development ◽

10.34117/bjdv7n7-600 ◽

2021 ◽

Vol 7 (7) ◽

pp. 74973-74982

Author(s):

Ana Catarina Viana Valle ◽

Aloisio Cunha De Carvalho

Keyword(s):

Complete Resolution ◽

Surgical Intervention ◽

Perianal Fistula ◽

Inflammatory Lesion ◽

The Other ◽

Perianal Region ◽

Clinical Routine ◽

Perianal Fistulas ◽

Therapeutic Protocol ◽

Complete Restoration

Perineal fistulas are frequently diagnosed in dogs in clinical practice. They are characterized by an inflammatory lesion in the perianal region or adjacent tissues, causing pain and discomfort to patients. In many cases, fistulas can be ulcerated. In general, corticosteroids and immunosuppressants are the treatment of choice for perianal fistulas. However, they cause various side effects. Surgical intervention is also an option, but sequelae may occur, such as fecal incontinence, the most frequent of them. From this perspective, it is evident that conventional treatments do not provide the complete restoration of the patients' health. On the other hand, homeopathic treatments are gaining space in the veterinary clinical routine with successful results for various diseases that affect animals. This study aimed to report the case of a German Spitz male dog diagnosed with perianal fistula exclusively treated by homeopathy. The prescription of medicines was based on the law of similars, and the medicines Arnica montana, Belladonna, Hamamellis virginiana, and Nitric acidum were chosen. The therapeutic protocol established restored the affected tissues' function with a complete resolution of the disease in 15 days. No complications were recorded.

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