O’Farril AR, Coyoli GO, Herrejón CJM, Toledo CC, Sánchez EA

Language: Spanish
References: 23
Page: 197-201
PDF size: 149.91 Kb.

ABSTRACT

Objective: To assess the usefulness of the 360° endoanal ultrasonography (USG) for preoperative identification of perianal fistulas, comparing its results with surgical findings.
Setting: Coloproctology service, Regional Hospital “Lic. Adolfo López Mateos”, ISSSTE (Social Security System for Government Employees)
Design: Prospective, longitudinal study, with diagnostic standard.
Statistical analysis: Sensitivity, specificity, KAPPA index.
Patients and methods: We studied 30 patients (22 men and 8 women), mean age of 42 years (range 33-59 years). A 360° endoanal USG was performed with a Brüel & Kjaer equipment at 7 MHz and applying H₂O₂ in the secondary fistulous orifice, identifying the tract and the originating crypt. The results were compared with the transoperative findings.
Results: From the total of patients studied with the preoperative USG, the causal crypt was found in 27 patients (90%) and the fistulous tract in 28 patients (93.33%), corresponding to 21 intersphincteric fistulas and 7 transsphincteric fistulas. Statistical analysis, comparing the result with the transoperative finding, the endoanal USG revealed a KAPPA index of 0.92 with a sensitivity of 96% and a specificity of 87% for the primary orifice; for the identification of the fistulous tract, sensitivity was of 98% and specificity was of 82%.
Conclusions: Endoanal USG is useful for the preoperative diagnosis and classification of anal fistulas.

REFERENCES

1. Mazier P. Surgery of the colon, rectum and anus. In: MacKeigan JM. Anorectal abscess and fistula in ano. Saunders Company, 1995: 269-78.

2. Corman ML. Colon & Rectal Surgery. 4th ed. New York. Lippincott-Raven, 1998: 224-37.

3. Charúa GL, Fierros GNE, Avendaño EO. Frecuencia de fístula anal secundaria a drenaje quirúrgico de absceso anal en el consultorio. Rev Med Hosp Gen Mex 2004; 67: 130-134.

4. Nelson R. Anorectal abscess fistula: what do we know? Surg Clin North Am 2002; 82: 1139-51.

5. Milsom JW, Lavery IC, Stolfi VM, Czyrko C, Church JH, Oakley JR, et al. The expanding utility of endoluminal ultrasonography in the management of rectal cancer. Surgery 1992; 112: 832-41.

6. Poen AC, Felt-Bersma RJ, Eijsbouts QA, Cuesta MA, Meuwissen SG. Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum 1998; 41: 1147-52.

7. Navarro-Luna, A, García-Domingo MI, Rius-Macías J, Marco-Molina C. Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Dis Colon Rectum 2004; 47: 108-14.

8. Londoño-Schimmer, E. Restrepo-Uribe S. La resonancia magnética en la evaluación del piso pélvico y el periné. Cir Ciruj 2002; 70: 173-78.

9. Schwartz DA, Wiersema MJ, Dudiak KM, Fletcher JG, Clain JE, Tremaine WJ, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluating of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064-72.

10. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg 2000; 24: 208-15.

11. Kruskal JB, Kane RA, Morrin MM. Peroxide enhanced anal endosonography: technique, image interpretation, and clinical applications. Radiographics 2001; 21: S173-89.

12. Cheong DM, Nogueras JJ, Wexner SD, Jagelman DG. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum 1993; 36: 1158-60.

13. Ortiz H, Marzo J, Jiménez G, DeMiguel M. Accuracy of hydrogen peroxide-enhanced ultrasound in the identification of internal openings of anal fistulas. Colorectal Disease 2002; 4: 280-283.

14. Schwartz DA, Harewood GC, Wiersema MJ. EUS for rectal disease. Gastrointest Endosc 2002; 56: 100-109.

15. Cho DY. Endosonographic criteria for an internal opening of fistula-in-ano. Dis Colon Rectum 1999; 42: 515-18.

16. Buchanan GN, Bartram CI, Williams AB, Halligan S, Cohen CR. Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-in-ano. Dis Colon Rectum 2005; 48: 141-47.

17. Chew SS, Yang JL, Newstead GL, Douglas PR. Anal fistula: Levovist-enhanced endoanal ultrasound: a pilot study. Dis Colon Rectum 2003; 46: 377-84.

18. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg 2000; 24: 208-15.

19. Lunniss PJ, Barker PG, Sultan AH, Armstrong P, Reznek RH, Bartram CI, et al. Magnetic resonance imaging of fistula-in-ano. Dis Colon Rectum 1994; 37: 708-18.

20. Fazio VW. Complex anal fistulae. Gastroenterol Clin North Am 1987; 16: 93-114.

21. Gustafsson UM, Kahvecioglu B, Aström G, Ahlström H, Graf W. Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study. Colorectal Dis 2001; 3: 189-97.

22. West RL, Zimmerman DD, Dwarkasing S, Hussain SM, Hop WC, Schouten WR, 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: 1407-15.

23. Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal crytoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Colon Rectum 1978; 21: 237-54.