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Volume 2023, Issue 2
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

This study aimed to evaluate the feasibility of preoperative transperineal ultrasound (TPUS) in evaluating perianal abscesses and fistulas under a resource-limited setting and compared it with surgical findings as gold standards.

A retrospective study conducted between February 2017 and March 2020, involving 85 patients who were presented to the emergency department with suspected perianal suppurative conditions and underwent TPUS with a 4- to 7-MHz curved transducer, were enrolled. Perianal abscesses and fistulas were classified according to the American Gastroenterological Association criteria and Parks’ classification. Data on patients’ characteristics, TPUS findings, and operative findings were analyzed. The sensitivity and accuracy of preoperative TPUS in detecting lesions were assessed and compared with the surgical findings as gold standards.

The mean age of study participants was 32.12 ± 13.83 years and there were 69 (81.2%) men and 16 (18.8%) women. The TPUS findings were consistent with surgical results in 74 out of 85 patients. In 11 out of the 85 cases, preoperative TPUS missed the diagnosis, and in 5 (6.7%) out of 74 cases, TPUS showed other abnormalities. Perianal abscesses, fistula, and mixed abscesses (with fistula or sinus) were observed in 29 (39.2%), 34 (46%), and 6 (8.1%) cases, respectively. The sensitivity, specificity, and overall accuracy of TPUS in detecting perianal abscesses and fistulas were 86%, 100%, and 87%, respectively. TPUS correctly detected all perianal abscesses with their subtypes (sensitivity of 100%, excellent degree of correlation, = 1). In the case of fistulas, the accuracy of TPUS in detecting subtype fistula was 87.5% (excellent degree of correlation, = 0.81); however, it showed low sensitivity in identifying suprasphincteric fistula (5/10, 50%). Additionally, the accuracy of TPUS in detecting the number of external openings was 87.5%, with a reasonable degree of correlation ( = 0.78). However, the accuracy of TPUS in detecting the site of internal openings and tracts of the fistula was 82% and 95%, respectively. Within a mean follow-up of 6.571 ± 1.72 months, there was a recurrence in one fistula patient.

Although the TPUS was not precise enough to diagnose suprasphincteric fistulas, it provides good diagnostic accuracy in identifying perianal abscesses and fistulas. Under resource-limited settings where MRI is unavailable or under emergencies, we recommend TPUS as the first diagnostic test for patients with perianal abscesses and fistulas.

© 2023 Altam, Homesh, Al-Kubati, Nasr, Ahmed, Alsaaidi, Aljbri, Fazea, Alyhari, Badheeb, Al-Naggar, licensee HBKU Press.
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2023-07-05
2025-01-23
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/content/journals/10.5339/jemtac.2023.24
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Feasibility of using transperineal ultrasound as a diagnostic test in perianal abscesses and fistulas under resource-limited setting: A retrospective study
Journal of Emergency Medicine, Trauma and Acute Care 2023, 24 (2023); https://doi.org/10.5339/jemtac.2023.24
/content/journals/10.5339/jemtac.2023.24
/content/journals/10.5339/jemtac.2023.24
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Keyword(s): operative findings, perianal abscess, perianal fistula, sensitivity and transperineal ultrasound

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