Imaging of Anorectal Fistula

Efficient and accurate classification and assessment of anorectal fistula is a fundamental component of successful patient management. Advances in technology have paved the way for development of minimally invasive imaging tests that equip the surgeon with a preoperative fistula roadmap and forewarns of unsuspected extensions. This information is complementary to examination under anesthetic and enables surgeons to choose the optimal operative approach, which aims to eliminate sepsis while preserving patient continence. More recently, magnetic resonance imaging findings have been used to guide selection and monitor the effect of nonoperative treatment strategies including biological drugs. This article aims to discuss the rationale for imaging and to review the options available.