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Can transcutaneous perianal ultrasonography be the first-line diagnostic instrument for evaluating pediatric perianal
Yu-Wen Ding1, Hao-Qiang Yin2, Hong-Tao Liang1
1Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China.
Insights
Transcutaneous perianal ultrasound accurately diagnoses pediatric perianal fistulas, identifying fistula tract complexity and internal opening (IO) location. This non-invasive imaging is a reliable first-line diagnostic tool for children.
Area of Science:
- Pediatric surgery
- Diagnostic imaging
- Gastroenterology
Background:
- Pediatric perianal fistula is a common condition.
- Detecting the fistula tract and internal opening (IO) in children presents diagnostic challenges.
- Accurate diagnosis is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the clinical diagnostic value of transcutaneous perianal ultrasound in children with perianal fistula.
- To assess the accuracy of ultrasound in identifying fistula tract complexity and IO location.
- To compare ultrasound findings with intraoperative exploration results.
Main Methods:
- Retrospective review of 203 pediatric patients (<3 years old) with perianal fistula.
- Analysis of preoperative transcutaneous perianal ultrasound and intraoperative exploration data.
- Evaluation of ultrasound accuracy and consistency in diagnosing fistula complexity and IO location.
Main Results:
- Transcutaneous perianal ultrasound demonstrated near-perfect agreement (Kappa = 0.881) with intraoperative findings for fistula tract complexity and IO.
- Sensitivity was 92% and specificity was 97% for ultrasound diagnosis.
- High consistency was observed in identifying IO location across all quadrants, with main distribution in Quadrants IV and II.
Conclusions:
- Transcutaneous perianal ultrasound is a highly accurate, non-invasive imaging technique for diagnosing pediatric perianal fistulas.
- It effectively identifies fistula classification and internal opening location.
- Ultrasound should be considered a first-line diagnostic instrument for evaluating perianal fistulas in children.
Background:
Pediatric perianal fistula is a common disorder. It is more difficult to detect the fistula tract and internal opening (IO) in children than in adults. This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula.
Methods:
A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were <3 years old and diagnosed with perianal fistula. Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas.
Results:
Compared with intraoperative exploration, the preoperative transcutaneous perianal ultrasonography has almost perfect agreement (Kappa = 0.881, P < 0.001) in the diagnosis of fistula tract complexity and IO with a sensitivity of 92% and a specificity of 97%. In addition, both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas (Quadrant I Kappa = 0.831, Quadrant II Kappa = 0.773, Quadrant III Kappa = 0.735, Quadrant IV Kappa = 0.802, all P < 0.01). The IOs were mainly distributed in Quadrants IV and II in both simple and complex fistulas.
Conclusions:
Transcutaneous perianal ultrasound, as a non-invasive and simple imaging technique, showed high accuracy in the diagnosis and identification of the fistula classification and IO location. It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children.
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