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Abstract

DEFFERENT IMAGING TECHNIQUES FOR ASSESSMENT OF FISTULA-IN-ANO: A REVIEW

Dr. Deep Chand Goan*

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Abstract

Background: Fistula is a Latin word for a pipe like structure or it is like a flute. From the surgical point of view it denotes a chronic granulating track connecting two epithelial lined surfaces. These may be cutaneous or mucosal. A correct identification of the primary source of crypt infection along with a complete understanding of the anatomical course of primary and secondary tracks and abscesses is a prerequisite for the successful management of fistula. Preoperative evaluation of fistula-in-ano using radio-imaging techniques provides a handy insight of fistula anatomy and helps in planning the appropriate treatment strategy. The objective of this article is to review the role of different radio-imaging techniques in the diagnosis and assessment of fistula-in-ano along with their advantages and disadvantages over one another. Main text: A comprehensive literature review was performed searching through the electronic databases as well as the standard textbooks of colorectal surgery. X-rays (plain radiographs and contrast fistulography), computed tomography (CT) scanning, transrectal ultrasonography (TRUS/EUS) and magnetic resonance (MR) imaging are the modalities used for preoperative imaging of fistula-in-ano. Due to low accuracy, X-ray fistulography is not used now for fistula imaging. CT fistulography can be more accurate in cases associated with acute inflammations and abscesses and the fistulas related with inflammatory bowel disease. Transrectal ultrasonography (TRUS) and MRI are two of the mostly used and reliable imaging techniques for fistula-in-ano. Though the use of a 3D technology has improved the accuracy of TRUS, MRI is the preferred choice by many. However, various reports have depicted comparable accuracies for both MRI and. Transrectal ultrasonography showing both to be equally sensitive but MRI to be more specific. 3D-Transrectal ultrasonography, on the other hand, is more rapid and can also be used intraoperatively to provide live imaging during surgical exploration. Conclusion: Complex and recurrent fistula cases should undergo a preoperative imaging to reduce the chances of recurrence. MRI is recommended as the imaging modality of choice for such cases. 3D anal endosonography may however be a good option over MRI owing to its rapidity, availability, and potential of intraoperative assistance during surgery.

Keywords: Fistula-in-ano, X-ray fistulography, CT scanning, Transrectal ultrasonography, MR imaging.


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