MRI Assessment of Perianal Fistula

Abstract

Background: A perianal fistula causes significant morbidity in patients. Previous to MR examination classification of perianal fistulas was done by the surgical approach. Clinical findings derived from a combination of digital rectal examination, proctosigmoidoscopy and surgical exploration. Failure to identify complications like abscess and secondary track would consequent in recurrence of the disease and treatment failure. Subjects and Methods: From November 2019 to June 2021 (1.5 years), around 50 patients who have perianal fistula clinically identifies and referred for MR fistulogram to our department of PDU medical college, and hospital, Rajkot were included in the study. Results: Total 50 patients were in our study. 34 patients were males (68%) And 16 patients were females (32%). The intersphincteric fistula was the most prevalent type of fistula seen in 19 of the patients (50%). The most common age group affected by fistulas was 41 to 50 years (38%). With reference to St James’s University Hospital Classification grade I fistulas were the commonest fistula and was found in 19 patients (38%). 22 patients out of 50 showed contrast enhancement which helped in the diagnosis of secondary tracts and abscesses better. Surgical findings and MRI findings for grades 3 to 5 were concordant. While Grade 1 and 2 fistulas showed little discrepancies in identification. Drainage of abscess was done in 4 patients (8%) which were in accordance with MRI findings. Conclusion: MRI imaging is most advantageous because of excellent soft tissue enhancement, detailed evaluation of track and its relation to anal sphincter, related complications, and coexisting secondary tracts. All this will help in better surgical approach and outcome and by this better prognosis of the disease.