1887
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.

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2023-07-05
2024-07-25
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References

  1. Mallouhi A, Bonatti H, Peer S, Lugger P, Conrad F, Bodner G. Detection and characterization of perianal inflammatory disease: Accuracy of transperineal combined gray scale and color Doppler sonography. J Ultrasound Med. 2004; 23:(1):19–27.
    [Google Scholar]
  2. Brillantino A, Iacobellis F, Reginelli A, Monaco L, Sodano B, Tufano G, et al. Preoperative assessment of simple and complex anorectal fistulas: Tridimensional endoanal ultrasound? Magnetic resonance? Both? Radiol Med. 2019; 124:(5):339–49.
    [Google Scholar]
  3. Tantiphlachiva K, Sahakitrungruang C, Pattanaarun J, Rojanasakul A. Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery. BMJ Open Gastroenterol. 2019; 6:(1):e000279.
    [Google Scholar]
  4. Jimenez M, Mandava N. Anorectal fistula. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
    [Google Scholar]
  5. Domkundwar SV, Shinagare AB. Role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano. J Ultrasound Med. 2007; 26:(1):29–36.
    [Google Scholar]
  6. Sun MRM, Smith MP, Kane RA. Current techniques in imaging of fistula in ano: Three-dimensional endoanal ultrasound and magnetic resonance imaging. Semin Ultrasound CT MR. 2008; 29:(6):454–71.
    [Google Scholar]
  7. Plaikner M, Loizides A, Peer S, Aigner F, Pecival D, Zbar A, et al. Transperineal ultrasonography as a complementary diagnostic tool in identifying acute perianal sepsis. Tech Coloproctol. 2014; 18:(2):165–71.
    [Google Scholar]
  8. Choen S, Burnett S, Bartram CI, Nicholls RJ. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg. 1991; 78:(4):445–7.
    [Google Scholar]
  9. Van Beers B, Grandin C, Kartheuser A, Hoang P, Mahieu P, Detry R, et al. MRI of complicated anal fistulae: Comparison with digital examination. J Comput Assist Tomogr. 1994; 18:(1):87–90.
    [Google Scholar]
  10. Sharma A, Yadav P, Sahu M, Verma A. Current imaging techniques for evaluation of fistula in ano: A review. Egypt J Radiol Nucl Med. 2020; 51::130.
    [Google Scholar]
  11. Singh A, Kaur G, Singh JI, Singh G. Role of transcutaneous perianal ultrasonography in evaluating perianal fistulae with MRI correlation. Indian J Radiol Imaging. 2022; 32:(1):51–61.
    [Google Scholar]
  12. Poggio JL. Current techniques in evaluating fistula-in-ano and perianal sepsis: Endorectal ultrasound technique and comparison in accuracy with surgery and magnetic resonance imaging. Semin Colon Rectal Surg. 2010; 21:(4):215–21.
    [Google Scholar]
  13. Hwang J-Y, Yoon H-K, Kim WK, Cho YA, Lee JS, Yoon CH, et al. Transperineal ultrasonography for evaluation of the perianal fistula and abscess in pediatric Crohn disease: Preliminary study. Ultrasonography. 2014; 33:(3):184–90.
    [Google Scholar]
  14. Maconi G, Greco MT, Asthana AK. Transperineal ultrasound for perianal fistulas and abscesses - A systematic review and meta-analysis. Ultraschall Med. 2017; 38:(3):265–72.
    [Google Scholar]
  15. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976; 63:(1):1–12.
    [Google Scholar]
  16. Cho DY. Endosonographic criteria for an internal opening of fistula-in-ano. Dis Colon Rectum. 1999; 42:(4):515–8.
    [Google Scholar]
  17. Puranik CI, Wadhwani VJ, Vora DM. Role of transperineal ultrasound in infective and inflammatory disorders. Indian J Radiol Imaging. 2017; 27:(4):482–7.
    [Google Scholar]
  18. Turner SV, Singh J. Perirectal abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
    [Google Scholar]
  19. 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 evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001; 121:(5):1064–72.
    [Google Scholar]
  20. Piccinini EE, Rosati G, Ugolini G, Marroccu S, Del Governatore M, Conti A. [Transanal ultrasonography in the study of fistulas of perianal abscess]. Minerva Chir. 1996; 51:(9):653–9.
    [Google Scholar]
  21. Jhobta A, Kaur R, Jhobta R, Dabra A, Kochhar S. Fistula in ano: Role of transperineal and transvaginal sonography. J Diagn Med Sonogr. 2006; 22:(6):375–81.
    [Google Scholar]
  22. Stewart LK, McGee J, Wilson SR. Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol. 2001; 177:(3):627–32.
    [Google Scholar]
  23. Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Milassin Á, et al. Prospective comparison of magnetic resonance imaging, transrectal and transperineal sonography, and surgical findings in complicated perianal crohn disease. J Ultrasound Med. 2016; 35:(11):2367–72.
    [Google Scholar]
  24. Mazier WP. The treatment and care of anal fistulas: A study of 1,000 patients. Dis Colon Rectum. 1971; 14:(2):134–44.
    [Google Scholar]
  25. Jabeen N, Qureshi R, Sattar A, Baloch M. Diagnostic accuracy of short tau inversion recovery as a limited protocol for diagnosing perianal fistula. Cureus. 2019; 11:(12):e6398.
    [Google Scholar]
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