The role of transperineal ultrasonography in the assessment of the internal opening of cryptogenic anal fistula

Kleinubing, Harry; Jannini, J. F.; Campos, Antônio Carlos; Pinho, Mauro; Ferreira, L. C.

doi:10.1007/s10151-007-0375-5

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…In particular, a recent systematic review has shown that MRI has similar high sensitivities and better specificity than endoanal US in detecting fistulae, but their specificity values are considered to be diagnostically poor. 18,20,26 The use of ultrasonographic intravenous contrast agents could improve the visualization of the wall of fistulae and abscesses enhancing their vascular tissue and the characterization of perianal abscesses. 23,24 This should be taken into consideration in patients affected by perianal CD, where the exclusion of abscess collections is imperative before the administration of an anti-tumor necrosis factor (TNF) therapy.…”

Section: Discussionmentioning

confidence: 99%

Transperineal Perineal Ultrasound Versus Magnetic Resonance Imaging In the Assessment of Perianal Crohnʼs Disease

Maconi

Tonolini

Monteleone

et al. 2013

Inflammatory Bowel Diseases

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Section: Discussionmentioning

confidence: 99%

Transperineal Perineal Ultrasound Versus Magnetic Resonance Imaging In the Assessment of Perianal Crohnʼs Disease

Maconi

Tonolini

Monteleone

et al. 2013

Inflammatory Bowel Diseases

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“…Despite the continuous improvement in preoperative imaging [2,3], the reported recurrence rates vary from 8 to as high as 40% [4]. Recurrent fistula-in-ano carries a significant morbidity affecting the quality of life (QOL) due to the disease as well as due to repeated operations [5].…”

Section: Introductionmentioning

confidence: 99%

Quality of life following surgery for recurrent fistula-in-ano

2009

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“…Vaginal endosonography, used to visualize the perianal area and especially the perineum, is an alternative when rectal endosonography is not possible because the anus is asymmetrical, causing air artifacts, extreme anal stenosis, or pain[29]. TPUS is also used to image the perianal area in patients with perianal fistula[30,31] or imperforate anus[31]. However, results using EUS seem somewhat better[32,33].…”

Section: Discussionmentioning

confidence: 99%

Sonographic appearance of anal cushions of hemorrhoids

Aimaiti¹,

Re²,

Ibrahim³

et al. 2017

WJG

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AIMTo evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient.RESULTSAll healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen’s kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between “mosaic pattern” in the TPUS and arteriovenous fistula in pathology was very good (ĸ = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05).CONCLUSIONPatients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a “mosaic pattern” in sonography, which is in accord with an arteriovenous fistula in path...

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The role of transperineal ultrasonography in the assessment of the internal opening of cryptogenic anal fistula

Abstract: TPUS and E-TPUS are superior to physical examination in the identification of internal openings in anal fistulas. Hydrogen peroxide injection does not provide additional advantages.

Cited by 15 publications

References 25 publications

Transperineal Perineal Ultrasound Versus Magnetic Resonance Imaging In the Assessment of Perianal Crohnʼs Disease

Transperineal Perineal Ultrasound Versus Magnetic Resonance Imaging In the Assessment of Perianal Crohnʼs Disease

Quality of life following surgery for recurrent fistula-in-ano

Sonographic appearance of anal cushions of hemorrhoids

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