Is simple fistula-in-ano simple?

Sangwan, Yash P.; Rosen, Les; Riether, Robert D.; Stasik, John J.; Sheets, James A.; Khubchandani, Indru T.

doi:10.1007/bf02052593

Cited by 127 publications

(82 citation statements)

References 20 publications

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“…Since prior sonographic examinations had indicated that the fistulous remnant was present before the earlier surgery for perianal abscess, one might speculate that the 4 recurrences in our patient may have been associated with a previously unrecognized fistulous extension, inadequate prior surgical management, or perhaps premature wound closure. 3,8 This possibility is supported by the results of our microscopic examination of the tissue fragments removed at surgery, by the sonographic and surgical findings, and by the previous fistulographic findings, all of which were consistent with the location of a prior fistula site.…”

Section: Discussionmentioning

confidence: 53%

Unusual sonographic finding in a patient with late recurrence of a perianal fistula

Mayoral¹,

Rubal²

2002

J of Clinical Ultrasound

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We describe a case of late recurrence of a perianal fistula in a 51-year-old man with a 4.5-year history of recurrent perianal fistulas and abscesses. This was the fourth recurrence he had experienced; at each occurrence, he had undergone various examinations, including sigmoidoscopy, anoscopy, barium enema, fistulography, probe exploration, instillation of hydrogen peroxide, and/or sonography, and he had also undergone surgery. At our examination, transperineal sonography with a portable ultrasound scanner revealed an echogenic linear structure within the fistulous tract. Under endoanal sonographic guidance, surgery was performed, and a tan solid cylindrical structure longer than 2 cm was removed. Histopathologic examination revealed stratified squamous epithelium and soft tissue with substantial fibrosis and mild chronic inflammation, findings consistent with the characteristics of a remnant cast from a previous fistulous tract. Our findings suggest that some patients may benefit from relatively inexpensive sonographic examination with appropriate transducers.

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Section: Discussionmentioning

confidence: 53%

Unusual sonographic finding in a patient with late recurrence of a perianal fistula

Mayoral¹,

Rubal²

2002

J of Clinical Ultrasound

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“…Approximately 32 to 52% of all recurrences occur in those cases in which an internal opening is not identified [12,14,15]. A failure to identify a secondary tract accounts for up to 38% of all recurrences [ 15,18]. Therefore, accurate assessment of the fistula is crucial to the success of fistula surgery and should include identification of the internal opening, course of the fistula, as well as the presence of any associated pathology (secondary tracts, abscesses).…”

Section: Discussionmentioning

confidence: 99%

“…Factors predictive of developing a postoperative recurrence foliowing fŸ surgery include the inability to locate the intemal opening and mismanagement of the fistula tract [15,18]. Approximately 32 to 52% of all recurrences occur in those cases in which an internal opening is not identified [12,14,15].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…However, some fistulas ate problematic and surgical treatment can lead to postoperative fecal incontinence of recurrence of the fistula. Up to 50% of all recurrences are in those cases in which an internal opening is not found, secondary tracts are not identified, of the primary tract is mismanaged [12,14,15,18]. Accordingly, successful fistula surgery depends on accurate pre-operative assessment.…”

Section: A Bernstein J J Nogueras E G Weiss Et Almentioning

confidence: 98%

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The use of endoanal ultrasonography in identifying fistula-in-ano

et al. 1997

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Summary. The aim of our study was to determine the accuracy of endoanal ultrasonography (EUS) in identifying fistula anatomy. Thirty-five patients with a diagnosis of fistula-in-ano underwent EUS. Internal openings, fistulas and associated pathology were documented. Image enhancement with hydrogen peroxide injection via the external opening was used in those patients whose fistulas or internal openings were not clearly seen on initial EUS. Twenty-eight of these patients underwent surgical intervention. Intra-operative findings were correlated with those from the EUS. Seven patients that did not undergo surgery following EUS were excluded from analysis. Three patients had negative examinations by ultrasound and subsequently underwent examination under anesthesia with confirmation of the absence of a fistula. Of the 25 patients with confirrned fistula-in-ano, tracts were identified in 22 patients and the internal opening was identified in 19 patients (associated pathology identified included 1 external anal sphincter defect and 10 abscesses [2 ischiorectal, 4 postanal and 4 perianal]). Without the aid of hydrogen peroxide injection 16 fistula tracts and 12 internal openings were identified. In the 9 patients whose tracts were not clearly seen, 8 were injected with hydrogen peroxide (1 was too tender for injection) and an additional 6 tracts were documented. Of the 13 patients whose internal openings were not clearly documented, 1 had an active abscess and was too tender for injection. Hydrogen peroxide helped to identify an additional 7 internal openings in the remaining patients. Of the 28 patients who underwent surgery, EUS accurately identified the presence of absence as well as the correct location of the tract in 24 patients (86%) and the internal opening in 24 patients (86%). The fistula tract was misinterpreted by EUS in 4 patients and the internal opening in 4 patients overall. Endoanal ultrasonography hada sensitivity of 95% and 92% for identification of the tract and internal opening, respectively, anda positive predictive value of 88% and 92% for the tract and internal opening, respectively. In conclusion EUS with hydrogen peroxide image enhancement is an excellent modality for eLucidating the anatomy of fistula-in-ano with a high positive predictive value and sensitivity.

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Evaluation of perianal sepsis: Comparison of anal endosonography and magnetic resonance imaging

Maier

Funovics

Kreuzer

et al. 2001

Magnetic Resonance Imaging

100

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The purpose of this study was to compare prospectively the diagnostic yield of anal endosonography (AES) and magnetic resonance imaging (MRI) in the assessment of perianal fistulae and abscesses. There were 39 patients (14 men, 25 women; mean age, 40 years) who underwent AES, performed with a 10-MHz rotating endoanal probe and MRI at 1.0 T (axial and coronal T2-weighted turbo spin-echo (TSE) and turbo-STIR sequences). Fistulae were classified as subcutaneous, intersphincteric, transsphincteric, high (i.e., high extrasphincteric or suprasphincteric), rectovaginal, and horseshoe and were compared with the surgical findings in all patients. Overall, 58 fistulae (subcutaneous, N ‫؍‬ 7; intersphincteric, N ‫؍‬ 9; transsphincteric, N ‫؍‬ 16; high, N ‫؍‬ 17; rectovaginal, N ‫؍‬ 5; and horseshoe, N ‫؍‬ 4) were detected at surgery. MRI showed a sensitivity of 84% and AES of 60% (P < .05). False-positive diagnoses were made in 6 patients (15%) with MRI and in 15 patients (26%) with AES, for a specificity of 68% and 21%, respectively (P < .05). Our findings show that MRI is superior to AES in the assessment of fistula-in-ano before major surgery. AES should be used only for orientation before minor procedures, such as incision or drainage of subcutaneous fistulae.

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Is simple fistula-in-ano simple?

Abstract: All so-called simple fistulas-in-ano may not have readily detectable primary openings and may possess secondary tracks which preclude their behavior as simple fistulas.

Cited by 127 publications

References 20 publications

Unusual sonographic finding in a patient with late recurrence of a perianal fistula

Unusual sonographic finding in a patient with late recurrence of a perianal fistula

The use of endoanal ultrasonography in identifying fistula-in-ano

Evaluation of perianal sepsis: Comparison of anal endosonography and magnetic resonance imaging

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