Seminars in Colon & Rectal Surgery
Volume 18, Issue 2 , Pages 111-121 , June 2007

Fistula-in-Ano: The Role of Imaging in Diagnosis and Presurgical Planning

  • Paul Knechtges, MD

      Affiliations

    • Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
    • Corresponding Author InformationAddress reprint requests to: Paul Knechtges, MD, Department of Radiology, University of Michigan Medical Center, 1600 Medical Center Drive, Taubman/Room B1 132L, Ann Arbor, MI 48109-0302.
  • ,
  • Gordon N. Buchanan, MD, MSc, FRCS (Gen)

      Affiliations

    • Hammersmith and Charing Cross Hospitals, London, United Kingdom.
  • ,
  • Jonathan Willatt, MD

      Affiliations

    • Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
  • ,
  • Andrew B. Williams, BSc, MS, FRCS (Gen)

      Affiliations

    • Guys and St. Thomas’s Hospitals, Lambeth Palace Road, London, United Kingdom.
  • ,
  • Isaac R. Francis, MD

      Affiliations

    • Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.

References 

  1. Nelson H. Cecil Textbook of Medicine. Philadelphia, PA: Saunders; 2004;
  2. Feldman M, Friedman LS, Brandt LJ, et al. Sleisenger and Fortran’s Gastrointestinal and Liver Disease. (ed 8). Philadelphia, PA: Saunders; 2006;
  3. Garcia-Aguilar J, Belmonte C, Wong WD, et al. Anal fistula surgery (Factors associated with recurrence and incontinence). Dis Colon Rectum. 1996;39:723–729
  4. Seow C, Phillips RK. Insights gained from the management of problematical anal fistulae at St. Mark’s Hospital, 1984-88. Br J Surg. 1991;78:539–541
  5. Halligan S, Stoker J. Imaging of fistula in ano. Radiology. 2006;239:18–33
  6. Kuijpers HC, Schulpen T. Fistulography for fistula-in-ano (Is it useful?). Dis Colon Rectum. 1985;28:103–104
  7. Buchanan GN, Halligan S, Bartram CI, et al. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004;233:674–681
  8. Buchanan G, Halligan S, Williams A, et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet. 2002;360:1661–1662
  9. Netter FH. Atlas of Human Anatomy. NJ: Ciba-Geigy, Summit; 1989;
  10. Noble J, Green HL, Levinson W, et al. Textbook of Primary Care Medicine. St. Louis: Mosby; 2001;
  11. Eisenhammer S. A new approach to the anorectal fistulous abscess based on the high intermuscular lesion. Surg Gynecol Obstet. 1958;106:595–599
  12. Parks AG. Pathogenesis and treatment of fistuila-in-ano. Br Med J. 1961;1:463–469
  13. Scoma JA, Salvati EP, Rubin RJ. Incidence of fistulas subsequent to anal abscesses. Dis Colon Rectum. 1974;17:357–359
  14. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12
  15. Buchanan GN, Williams AB, Bartram CI, et al. Potential clinical implications of direction of a trans-sphincteric anal fistula tract. Br J Surg. 2003;90:1250–1255
  16. Choen S, Burnett S, Bartram CI, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg. 1991;78:445–447
  17. Beckingham IJ, Spencer JA, Ward J, et al. Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano. Br J Surg. 1996;83:1396–1398
  18. Poen AC, Felt-Bersma RJ, Eijsbouts QA, et al. Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum. 1998;41:1147–1152
  19. Ratto C, Gentile E, Merico M, et al. How can the assessment of fistula-in-ano be improved?. Dis Colon Rectum. 2000;43:1375–1382
  20. Chapple KS, Spencer JA, Windsor AC, et al. Prognostic value of magnetic resonance imaging in the management of fistula-in-ano. Dis Colon Rectum. 2000;43:511–516
  21. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001;121:1064–1072
  22. Bartram CI. Anal endosonography. Ann Gastroenterol Hepatol (Paris). 1992;28:185–189
  23. Lindsey I, Humphreys MM, George BD, et al. The role of anal ultrasound in the management of anal fistulas. Colorectal Dis. 2002;4:118–122
  24. Bartram C, Frudinger A. A Handbook of Anal Endosonography. 1997;
  25. Bartram C, Buchanan G. Imaging anal fistula. Radiol Clin North Am. 2003;41:443–457
  26. Cheong DM, Nogueras JJ, Wexner SD, et al. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum. 1993;36:1158–1160
  27. Kruskal JB, Kane RA, Morrin MM. Peroxide-enhanced anal endosonography: technique, image interpretation, and clinical applications. Radiographics. 2001;21(Spec No):S173–S189
  28. Chew SS, Yang JL, Newstead GL, et al. Anal fistula: Levovist-enhanced endoanal ultrasound: a pilot study. Dis Colon Rectum. 2003;46:377–384
  29. Sudol-Szopinska I, Jakubowski W, Szczepkowski M. Contrast-enhanced endosonography for the diagnosis of anal and anovaginal fistulas. J Clin Ultrasound. 2002;30:145–150
  30. Navarro-Luna A, Garcia-Domingo MI, Rius-Macias J, et al. Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Dis Colon Rectum. 2004;47:108–114
  31. Buchanan GN, Bartram CI, Williams AB, et al. Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-in-ano. Dis Colon Rectum. 2005;48:141–147
  32. West RL, Zimmerman DD, Dwarkasing S, et al. Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum. 2003;46:1407–1415
  33. Halligan S, Bartram CI. MR imaging of fistula in ano: are endoanal coils the gold standard?. AJR Am J Roentgenol. 1998;171:407–412
  34. Lunniss PJ, Armstrong P, Barker PG, et al. Magnetic resonance imaging of anal fistulae. Lancet. 1992;340:394–396
  35. Halligan S, Buchanan G. MR imaging of fistula-in-ano. Eur J Radiol. 2003;47:98–107
  36. Barker PG, Lunniss PJ, Armstrong P, et al. Magnetic resonance imaging of fistula-in-ano: technique, interpretation and accuracy. Clin Radiol. 1994;49:7–13
  37. Beets-Tan RG, Beets GL, van der Hoop AG, et al. Preoperative MR imaging of anal fistulas: does it really help the surgeon?. Radiology. 2001;218:75–84
  38. Buchanan GN, Halligan S, Williams AB, et al. Magnetic resonance imaging for primary fistula in ano. Br J Surg. 2003;90:877–881
  39. Ratto C, Grillo E, Parello A, et al. Endoanal ultrasound-guided surgery for anal fistula. Endoscopy. 2005;37:722–728
  40. Zbar AP, Oyetunji RO, Gill R. Transperineal versus hydrogen peroxide-enhanced endoanal ultrasonography in never operated and recurrent cryptogenic fistula-in-ano: a pilot study. Tech Coloproctol. 2006;10:297–302
  41. Buchanan GN, Bartram CI, Phillips RK, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003;46:1167–1174
  42. Bell SJ, Halligan S, Windsor AC, et al. Response of fistulating Crohn’s disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther. 2003;17:387–393
  43. Rasul I, Wilson SR, MacRae H, et al. Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol. 2004;99:82–88
  44. Law PJ, Talbot RW, Bartram CI, et al. Anal endosonography in the evaluation of perianal sepsis and fistula-in-ano. Br J Surg. 1989;76:752–755
  45. Cataldo PA, Sanagore A, Luchtefeld MA. Intrarectal ultrasound evaluation of perirectal abscesses. Dis Colon Rectum. 1993;36:554–558
  46. Lunnis PJ, Barker PG, Sultan AH, et al. Magnetic Resonance Imaging of fistula-in-ano. Dis Colon Rectum. 1994;37:708–718
  47. Deen KI, Williams JG, Hutchinson R, et al. Fistulas in ano: endoanal ultrasonographic assessment assists decision making for surgery. Gut. 1994;35:319–394
  48. Hussain SM, Stoker J, Schouten WR, et al. Fistula in ano: endoanal sonography versus endoanal MR imaging in classification. Radiology. 1996;200:475–481
  49. Orsoni P, Barthet M, Portier F, et al. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease. Br J Surg. 1999;86:360–364
  50. Gustafsson UM, Kahvecioglu B, Astrom G, et al. Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study. Colorectal Dis. 2001;3:189–197
  51. Ortiz H, Marzo H, Jimenez G, et al. Accuracy of hydrogen peroxide-enhanced ultrasound in the identification of internal openings of anal fistulas. Colorectal Dis. 2002;4:280–283
  52. Lengyl AJ, Hurst NG, Williams JG, et al. Pre-operative assessment of anal fistulas using endoanal ultrasound. Colorectal Dis. 2002;4:436–440

PII: S1043-1489(07)00012-7

doi: 10.1053/j.scrs.2007.03.005

Seminars in Colon & Rectal Surgery
Volume 18, Issue 2 , Pages 111-121 , June 2007