scholarly journals Role of magnetic resonance imaging in diagnosis and grading of perianal fistulas

2021 ◽  
Vol 12 (12) ◽  
pp. 140-146
Author(s):  
Saurabh S Kakani ◽  
Devidas B Dahiphale ◽  
Saurabh G Padiya ◽  
Vimal G Dugad ◽  
Shivaji M Pole ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Anal Canal ◽  
Fistulous Tract ◽  
Perianal Fistula ◽  
Internal Opening ◽  
Perianal Area ◽  
Fistula In Ano ◽  
Perianal Fistulae ◽  
Transmural Inflammation

Background: Fistula-in-ano can be defined as a hollow tract or cavity which is lined by granulation tissue. In case of fistula-in-ano, one end of this fistula opens in the anal canal whereas the other end is located in perianal area. Fistula-in-ano can considerably affect quality of life of an individual because of perianal discharge of blood and pus. Imaging of these fistulas is an important part of management and MR imaging is important in assessing relationship between the fistulous tract and sphincter muscles. Moreover, MR imaging can reliably demonstrate transmural inflammation, secondary tracts/ramifications, and abscesses which cannot be diagnosed on the basis of conventional fistulography. Aims and Objectives: The aim of the study was to evaluate role of MRI in diagnosis and grading of perianal fistulae. Materials and Methods: This was a retrospective observational study, in which 60 patients with fistula-in-ano were included on the basis of a predefined inclusion and exclusion criteria. MR imaging of patients was done by 1.5 T MRI machine. Before MR imaging normal saline was injected in the fistulous tract from secondary/external opening, that is, opening around perianal area. Three plane images were obtained in all the cases. T1W, T2W, and STIR image sequences were obtained parallel to pelvic diaphragm. Coronal cuts were imaged parallel to anal canal. FAT suppressed T1W and T2W images in all cases. Type and grade of fistula were determined in all the cases. P < 0.05 was taken as statistically significant. Results: Out of total 60 patients, there were 46 (76.66%) males and 14 (23.33%) were females with a M:F ratio of 1:0.30. The mean age of male and female patients was found to be 41.93±8.96 years and 44.04±7.46 years, respectively. The most common type of fistula was found to be trans-sphincteric fistula which was seen in 31 (51.6%) cases followed by intersphencteric fistula 22 (36.6%). Extrasphincteric and suprasphincteric fistulae were relatively uncommon and were seen in 4 (6.66%) and 3 (5%) cases, respectively. MRI was accurate in diagnosis of the tract with position of internal opening and any abscess cavity or secondary tract in 23 patients. Therefore, the diagnostic accuracy of MRI was found to be 95.4%. Conclusion: MRI is an excellent tool in assessment of perianal fistula. It not only helps in precisely locating fistulous tract but also can demonstrate relationship between the fistulous tract and sphincter muscles. Moreover, it can very well demonstrate transmural inflammation, secondary tracts/ramifications, and abscesses which cannot be assessed by conventional fistulograms.

scholarly journals Role of video assisted anal fistula treatment in our management of fistula-in-ano

2014 ◽  
Vol 61 (2) ◽  
pp. 83-85 ◽  
Author(s):  
Tomáas Grolich ◽  
Tomás Skricka ◽  
Oldøich Robek ◽  
Zdenìk Kala ◽  
Beata Hemmelová ◽  
...  
Keyword(s):  
Anal Fistula ◽  
Perianal Fistula ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Chronic Fistula ◽  
Video Assisted ◽  
Seton Drainage ◽  
Fistula Treatment ◽  
Established Role

Background: Video-assisted anal fistula treatment is a new method used for treatment of complex perianal fistula with maximal sparing of sphincter muscles and prevention of false route. Authors inform about their experience and operative results. Aims: Our aim was to verify feasibility of the method, help in internal opening identification and define its position in our management of perianal fistulas. Methods: Patients with chronic fistula-in-ano of IBD and non-IBD benign etiology were enrolled. Anoscopy with fistuloscopy was attempted in all patients followed by loose seton drainage or other procedure. Results: Fistuloscopy was attempted in 30 patients, finished in 93% and internal opening was found in 67%. No procedure-related morbidity was observed. Conclusion: Fistuloscopy alone is feasible for diagnosing type of IBD and non-IBD fistulas. VAAFT technique and instruments were helpful for identification of an internal opening in most cases. As such it has established role in our management of fistula-in-ano.

scholarly journals Diagnostic Accuracy of MR Fistulography using Saline in the Evaluation of Perianal Fistula

2020 ◽  
Vol 7 (39) ◽  
pp. 2171-2175
Author(s):  
Adithya Das ◽  
Visakh Prasad
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Diagnostic Accuracy ◽  
Contrast Agent ◽  
Perianal Fistula ◽  
Internal Opening ◽  
Reference Standard ◽  
Resonance Imaging ◽  
Perianal Fistulae

BACKGROUND Magnetic resonance imaging is known to demonstrate the perianal anatomy accurately. MR Fistulography with saline as contrast agent has been described to facilitate the detection of fistula tracks. We wanted to study the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of magnetic resonance fistulography using saline as a contrast agent using surgical findings as a reference standard. METHODS Fifty-nine clinically diagnosed cases of perianal fistulae who were sent for preoperative MR imaging of the perianal fistulae were included in the study. MR imaging after instillation of saline was obtained in these patients through a cannula inserted into the external opening. T2 and STIR images in axial and coronal planes were studied. Diagnostic indices were calculated using surgical findings as reference standard. RESULTS MR imaging with saline instillation demonstrated a sensitivity of 97.92 % in the detection of primary tracks. The sensitivity in determination of internal opening, secondary tracks, abscesses and horseshoe tracks were 98.04 %, 95.24 %, 100 % and 100 % respectively. MRI had 100 % specificity in detection of primary tracks, internal opening, secondary tracks, abscesses and horseshoe tracks before and after instillation of saline. The sensitivity was found to be more in participants who did not have active perianal discharge at the time of MR examination. CONCLUSIONS MRI with instillation of saline into the fistulous track is highly accurate for the presurgical evaluation of perianal fistula with respect to accurate depiction of primary track, secondary track, abscess and horseshoe extensions. It can serve as a cheaper alternative to MR examination using I.V. Gadolinium based contrast agents or MR Fistulography using Gadolinium agents. KEYWORDS Magnetic Resonance Imaging (MRI), Perianal Fistula, Saline, Pre-Operative Assessment, Fistulography, Horseshoe, Internal Opening, Secondary Tracks

scholarly journals Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

2020 ◽  
Vol 7 (3) ◽  
pp. 721
Author(s):  
Davinder Koli ◽  
Pravin Kumar ◽  
Viraj Panda ◽  
Manu Vats
Keyword(s):  
Anal Fistula ◽  
Fistulous Tract ◽  
Significant Risk ◽  
Digital Rectal Examination ◽  
Fistula Tract ◽  
Internal Opening ◽  
Cyanoacrylate Glue ◽  
Fistula In Ano ◽  
Infant Feeding Tube

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

scholarly journals A comparative study in the management of fistula in ANO using various modalities

2018 ◽  
Vol 5 (6) ◽  
pp. 2223 ◽  
Author(s):  
Ramachandra M. L. ◽  
Mayank Garg
Keyword(s):  
Fistulous Tract ◽  
Selection Method ◽  
Fistula Tract ◽  
Internal Opening ◽  
Necrotic Tissue ◽  
Fistula In Ano ◽  
Sphincter Function ◽  
Medical College ◽  
Operative Complications ◽  
Comparative Prospective Study

Background: Fistula in ano is a track that connects deeply the anal canal or rectum to the skin around the anus. Fistula in ano most commonly follows an anorectal sepsis1. The main principles of management of anal fistula are closure of internal opening of fistula tract, drainage of infection or necrotic tissue, and eradication of fistulous tract with preservation of sphincter function. The objectives were to compare the various aspects like per operative complications, post-operative complications, mean hospital stay in the treatment of fistula in ano using various modalities like fistulotomy, fistulectomy, setons and lift procedure.Methods: This is a randomised, comparative, prospective study of 80 cases of fistula in ano, presenting at surgical opd of K.R. Hospital, Mysore attached to Mysore Medical College and research Institute. Out of which, 20 cases are treated by fistulectomy, 20 by seton, 20 by fistulotomy and the rest 20 cases by LIFT procedure by random selection method, during period of NOVEMBER 1, 2016 to 31st October 2017.Results: Most common age of presentation is 31-40 years and more common in males then females (M:F= 2.3:1 ). Per operative complications include bleeding seen more in patients undergoing fistulectomy. Per operative course of LIFT procedure patients was complication free. Postoperative pain seen more in patients undergoing setons procedure.Conclusions: we conclude that LIFT procedure and Fistulotomy were acceptable procedures for simple, uncomplicated low lying and high lying fistula.

Treatment of Perianal Fistulas in Poland

2015 ◽  
Vol 87 (12) ◽  
Author(s):  
Łukasz Dziki ◽  
Michał Mik ◽  
Radzisław Trzciński ◽  
Marcin Włodarczyk ◽  
Mariusz Skoneczny ◽  
...  
Keyword(s):  
Anal Canal ◽  
Granulation Tissue ◽  
Perianal Fistula ◽  
High Recurrence Rate ◽  
Perianal Area ◽  
Surgical Practice ◽  
Perianal Fistulas ◽  
Anonymous Questionnaire ◽  
Study Results ◽  
Fistula Treatment

AbstractA perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management.The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice.Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form.Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.

scholarly journals Study the Role of Loose versus cutting of Seton in Treatment of High Perianal fistula in a District Hospital of Health Insurance

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Abdelhameed ◽  
I M H Elghazawy ◽  
E A Elsayed
Keyword(s):  
Anal Fistula ◽  
Low Cost ◽  
Perianal Fistula ◽  
Dentate Line ◽  
Internal Opening ◽  
Fistula In Ano ◽  
One Year ◽  
Definition Of ◽  
A Prospective Study ◽  
High Perianal Fistula

Abstract When the track reaches the skin or another epithelialized surface then a fistula is formed. Anal fistula were classified on the basis of its relationship to the sphincters. The definition of high or low describes the height of the track as it traverses the sphincter muscles and not the position of the internal opening which is almost without exception at the dentate line. More accurately according to parks classification fistula in ano can result in an abscess between the internal and external sphincters, which in turn can spread to other parts of the perianal region. Infection can then track in many directions from this focus in the intersphincteric plane. Background Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula. Objectives Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 30 patients in ELNile hospital in one Year period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction. Result Among 30 patients mean age was 42.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 27 patients, incontinence occurred in 3 patients and recurrence occurred in 3 patients. Conclusion Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.

scholarly journals Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae

2021 ◽  
Author(s):  
Deb K. Boruah ◽  
Karuna Hazarika ◽  
Halimuddin Ahmed ◽  
Krishna K. Borah ◽  
Samudra Borah ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Imaging Modality ◽  
Perianal Fistula ◽  
P Value ◽  
Adc Value ◽  
Perianal Fistulas ◽  
Diffusion Weighted ◽  
Significant Difference ◽  
Perianal Fistulae

Abstract Background Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating perianal fistulae, due to its ability to show the relationship of perianal fistulae with anal sphincters, fistula extensions, secondary ramifications and associated complications. Aim To evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Settings and Design A hospital-based cross-sectional study. Materials and Methods The study group composed of 47 patients of perianal fistula. MRI with diffusion-weighted imaging (DWI) was performed with Philips 0.5 T Ingenia scanner. DWI with different b-values (b = 50, b = 400, and b = 800 smm2) were obtained. The MRI findings were correlated with local clinical examination and or surgical findings. Statistical Analysis Used Chi-square test, independent samples t-test, and receiver operating characteristic curve analysis. Result Fifty-nine perianal fistulas in 47 patients were included in the study sample. The visibility of perianal fistula on DWI was less than T2-weighted (T2W) and combined DWI-T2W images. Distinctly visualized (visibility score 2) perianal fistulas were observed in 47 fistulas (79.6%) on DWI, 54 (91.5%) on T2W, and 58 (98.3%) on DWI-T2W images. The mean of apparent diffusion coefficient (ADC) values of active fistula was 0.972 ± 0.127 [SD] 10−3 mm2/s and inactive was 1.232 ± 0.185 [SD] 10−3 mm2/s with a significant difference (p-value < 0.0005). A cut-off mean ADC value of 1.105 × 10−3 mm2/s was used to differentiate active from the inactive fistula with a sensitivity of 87.5% and specificity of 73.3%. Conclusion Combined DWI-T2W evaluation had a better performance in the detection of fistula than DWI or T2W alone. DWI with mean ADC calculation had a good performance in differentiating active from the inactive fistulas.

scholarly journals The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

2020 ◽  
Author(s):  
Ruvindu H Waidyasekera ◽  
Umesh Jayarajah ◽  
Dharmabandhu Nandadeva Samarasekera
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Incidental Findings ◽  
Flexible Sigmoidoscopy ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Recurrent Fistula ◽  
Associated Symptoms

Abstract Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded. Results: The median age was 39(range:14-74) years and the majority were males(n=128,80.5%). Forty-nine patients(30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n=5, 3.1%) and polyps (n=7, 4.4%) were found. One patient(0.6%) had a healed anal fissure, 5 patients(3.1%) had inflamed mucosa and 2 patients(1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn’s disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn’s disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.

scholarly journals a Video Assisted Anal Fistula Treatment “VAAFT Technique” for Anal Fistulas

2018 ◽  
Vol 6 (04) ◽  
Author(s):  
Devashis Biswas ◽  
Kavya ramrao Kadapi
Keyword(s):  
External Surface ◽  
Fistulous Tract ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Fistula In Ano ◽  
Infection Treatment ◽  
Anorectal Region ◽  
Fistula Treatment ◽  
Histopathological Investigation ◽  
Rule Out

Fistula in ano -: It is a complete tract with two openings in anorectal region, one in the external surface, second in the anal canal or in higher anatomical structures1. Fistula in ano commonly develops as a symptomatic or asymptomatic abscess due to cryptoglandular infection; treatment depends upon the location of the anatomy or tract of the fistula. General principle for management of Fistula in ano-Irrigation of the whole fistulous tract, part of the fistulous track which is opened outside  should be excised, obliteration of the internal opening is the key of success, excised tract should be send for histopathological investigation to rule out other pathology e.g Tuberculosis.

scholarly journals Stem Cell Therapy: A Compassionate Use Program in Perianal Fistula

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
M. D. Herreros ◽  
D. Garcia-Olmo ◽  
H. Guadalajara ◽  
T. Georgiev-Hristov ◽  
L. Brandariz ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Partial Response ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Perianal Fistula ◽  
Internal Opening ◽  
Compassionate Use ◽  
Fistula In Ano

Aim. To report our experience in a compassionate use program for complex perianal fistula. Methods. Under controlled circumstances and approved by European and Spanish laws, a compassionate use program allows the use of stem cell therapy for patients with nonhealing diseases, mostly complex fistula-in-ano, who do not meet criteria to be included in a clinical trial. Candidates had previously undergone multiple surgical interventions that had failed. The intervention consisted of surgery (with closure of the internal opening or a surgical flap performance), followed by stem cell injection. Three types of cells were used for implant: stromal vascular fraction, autologous expanded adipose-derived, or allogenic adipose-derived stem cells. Healing was evaluated at 6th month follow-up. Outcome was classified as partial response or healing. Relapse was evaluated 1 year later. Maximum follow-up period was 48 months. Results. 45 patients (24 male) were included; the mean age was 45 years, which ranged from 24 to 69 years. Since some of them received repeated doses, 52 cases were considered (42 fistula-in-ano, 7 rectovaginal fistulas, 1 urethrorectal fistula, 1 sacral fistula, and 1 hidradenitis suppurativa). Regarding fistula-in-ano, there were 18 Crohn’s-associated and 24 cryptoglandular. 49 cases (94.2%) showed partial response starting 6.5 weeks of follow-up. 24 cases (46.2%) healed in a mean time of 5.5 months. A year later, all patients cured remained healed. No adverse effects related to stem cell therapy were reported. Conclusion. Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases.

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