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Congress: ECR24
Poster Number: C-13292
Type: EPOS Radiologist (educational)
DOI: 10.26044/ecr2024/C-13292
Authorblock: J. A. Morbelli, M. C. Álvarez Fernández, M. Á. Luceño Ros, U. Sobrino Castro, M. Coma García, C. Álvarez Fernández; León/ES
Disclosures:
Juan Antonio Morbelli: Nothing to disclose
María Covandonga Álvarez Fernández: Nothing to disclose
María Ángeles Luceño Ros: Nothing to disclose
Uxia Sobrino Castro: Nothing to disclose
Marta Coma García: Nothing to disclose
Cesar Álvarez Fernández: Nothing to disclose
Keywords: Anatomy, Gastrointestinal tract, Pelvis, CT, MR, Diagnostic procedure, Abscess, Fistula
Learning objectives To convey the basis for the assessment, diagnosis and reporting of perianal fistulas.
Read more Background Perianal fistulas are a frequent concern in patients with inflammatory bowel disease, specially Crohn's disease, but can also be a complication on multitude of other diseases or be found on otherwise healthy patients. Fistulas are often recurring and hard to treat, and may need multiple management strategies including surgery.An accurate imaging methodology, understanding of the imaging characteristics and precise reporting of perianal fistulas is fundamental for a correct clinical management.
Read more Findings and procedure details AnatomyTo talk about perianal fistulas, first must be discussed the anatomy of the anal canal and the perineum. The anal canal comprises the final 1 to 3 cm of GI tract and is the continuation of the rectum into the perineum. Anatomically, the pelvis and the perineum are separated by the levator ani muscle which will accompany the anal canal downwards comprising the external anal sphincter, while the internal anal sphincter is a continuation of the rectum wall. In between...
Read more Conclusion Perianal fistulas are better assessed via MRI. Knowledge of the regional anatomy is fundamental in providing an accurate description of each fistula.A proper radiological report must include the origin of the fistula, the anatomy of the fistulous tract, the presence of secondary tracts or abscesses, inflammatory activity and external orifice.Various classifications exist for perianal fistulas, the most used being the Parks classification and the St. James Hospital classification. Both are equally valid, and good communication with the surgical team that...
Read more References Choe J, Wortman JR, Sodickson AD, Khurana B, Uyeda JW. Imaging of Acute Conditions of the Perineum. RadioGraphics 2018;38(4):1111–1130.Simpson JA, Banerjea A, Scholefield JH. Management of anal fistula. BMJ 2012;345(oct15 4):e6705–e6705.Sheedy SP, Bruining DH, Dozois EJ, Faubion WA, Fletcher JG. MR Imaging of Perianal Crohn Disease. Radiology 2017;282(3):628–645.Ramírez Pedraza N, Pérez Segovia AH, Garay Mora JA, et al. Perianal Fistula and Abscess: An Imaging Guide for Beginners. RadioGraphics 2022;42(7):E208–E209.Thipphavong S, Costa AF, Ali HA, Wang DC, Brar MS, Jhaveri KS....
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