MRI in the Workup of Patients with Perianal Fistulas

Dr. Jay Hapani, Dr. Kartik Nookala, Dr. Hiral Hapani, Dr. Anjana Trivedi

Abstract: Fistula - in - ano or anorectal fistula is an abnormal tract that often develops from the anal canal to the perianal region. Fistula - in - ano is annoying problem because of high recurrence rates and severe unexpected complications postoperatively. Surgery is considered the treatment of choice aiming to avoid recurrence and preserve anal sphincter function. The risk of recurrence increases if surgeons fail to recognize and remove radically a fistula and its associated elements during corrective surgery, especially internal openings and secondary tracts. Accordingly, a precise and comprehensive preoperative assessment of fistulous tract is a pivotal diagnostic strategy and contributes significantly to the success rate of surgery. Before the era of magnetic resonance imaging (MRI), fistulography was used to evaluate fistula - in - ano. However, this technique has a low diagnostic accuracy (~18%), and inability to visualize secondary tracts, and the sphincter complex due to its suboptimal contrast opacification. As a result, fistulograms are not able to provide information about the relationship between fistula tracts and anal sphincters. Magnetic resonance imaging (MRI) has been considered the gold standard procedure for assessment of perianal fistula as it provides the surgeon with an accurate roadmap to select the best surgical approach, determines the extent of sphincter division, and estimates the risk of postoperative incontinence. Conclusion: MRI fistulography is an excellent guide for diagnosis, surgical intervention and has emerged as an imaging modality of choice.

Keywords: MRI, Ano - rectal fistulas, Perianal fistulae, Preoperative assessment, surgical management

How to Cite?: Dr. Jay Hapani, Dr. Kartik Nookala, Dr. Hiral Hapani, Dr. Anjana Trivedi, "MRI in the Workup of Patients with Perianal Fistulas", Volume 13 Issue 5, May 2024, International Journal of Science and Research (IJSR), Pages: 667-673, https://www.ijsr.net/getabstract.php?paperid=SR24510141302, DOI: https://dx.doi.org/10.21275/SR24510141302