Related Experiment Videos
Significance of MRI in the treatment of perianal fistula
1IVth Department of Surgery, University Hospital, Comenius University, Bratislava, Slovakia. bll@fmed.uniba.sk
Objectives:
Objective of the study was to examine patients with fistula preoperatively with MRI and then compare with operative findings.
Background:
Most common cause of perianal suppuration is infection of cryptoglandular origin. This results in simple intersphincteric abscess, or spreading of infection in cranial or caudal direction, horizontally or circulary. To choose the correct surgical therapy, sufficient diagnostic is necessary. This includes clinical examination, endorectal ultrasonography, rectoscopy with fistula injection with hydrogen peroxide or dye. More and more often MRI is used.
Methods:
In 2007 19 patients with perianal fistula were operated on. In 14 patients, preoperative MRI was done without contrast dye or probing. Fistulas were classified on 5-grade scale. We treated simple fistulas with fistulectomies, in three cases of complicated fistulas cutting setons were used.
Results:
We examined 14 patients and confronted preoperative MRI result with operative findings. In 12 patients results matched, in two patients peroperatively diagnosed and treated fistula did not show on MRI. One was transsphincteric fistula with abscess and one was simple transsphincteric fistula.Because of low number of patients, statistical interpretations are not significant.
Conclusions:
Results are preliminary, we continue in prospective analysis. MRI may be useful for successful treatment by correct assessment of the extent of disease. It is necessary to consider cost-effectiveness when indicating MRI (Tab. 6, Fig. 3, Ref. 11). Full Text (Free, PDF) www.bmj.sk.
Insights
Magnetic Resonance Imaging (MRI) shows promise in assessing perianal fistulas, accurately identifying the extent of disease in most cases. Further research is needed to confirm its cost-effectiveness in surgical planning.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Diagnostics
Background:
- Perianal suppuration commonly originates from cryptoglandular infections, leading to various fistula types.
- Accurate diagnosis is crucial for effective surgical therapy, with MRI increasingly utilized alongside traditional methods.
- Preoperative assessment aids in selecting appropriate surgical techniques for perianal fistulas.
Purpose of the Study:
- To evaluate the efficacy of preoperative Magnetic Resonance Imaging (MRI) in diagnosing perianal fistulas.
- To compare MRI findings with intraoperative surgical observations.
- To assess the potential of MRI in guiding surgical treatment of perianal fistulas.
Main Methods:
- A prospective study involving 19 patients undergoing surgery for perianal fistulas in 2007.
- Preoperative MRI without contrast or probing was performed on 14 patients.
- Fistulas were classified using a 5-grade scale, with surgical treatments including fistulectomies and cutting setons.
Main Results:
- MRI findings were compared with operative results in 14 patients.
- A concordance between MRI and operative findings was observed in 12 patients (85.7%).
- Two cases of transsphincteric fistulas (one with abscess) were not detected by MRI, highlighting potential limitations.
Conclusions:
- Preliminary results suggest MRI is a valuable tool for assessing perianal fistula extent, aiding treatment planning.
- Further prospective analysis is ongoing to validate these findings.
- The cost-effectiveness of indicating MRI for perianal fistula assessment requires careful consideration.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...