Perianal Fistüllerin İncelenmesinde Manyetik Rezonans Görüntülemenin Rolü

Yıl 2018, Cilt: 15 Sayı: 1, 25 - 30, 22.04.2018

Muhammed Arslan Zehra Adıbelli Fevzi Cengiz Gökhan Söker

Öz

Amaç: Biz çalışmamızda perianal fistül, ikincil
uzantılar ve perianal apselerin manyetik rezonans görüntüleme ile
gösterilmesini ve cerrahi tedaviye katkısını değerlendirdik.

Materyal ve Metod: İzmir Eğitim Araştırma
Hastanesi genel cerrahi kliniğinde fizik muayene ile perianal fistül tanısı
konan 29 hasta çalışmamıza kabul edildi. Manyetik rezonans görüntüleme ile
perianal fistüllerin tipleri belirlendi. Radyolojik görüntüleme sonrası opere
olan 29 hastanın operasyon sonrası tanısı ve uygulanan cerrahi yöntem
değerlendirildi.

Bulgular: Fizik muayene ile 14 hastada (% 48.3)
intersfinkterik,  13 hastada (% 44.8)
transsfinkterik,  2 hastada (% 6.9)
suprasfinkterik fistül saptandı. Manyetik rezonans görüntüleme ile fistül
lokalizasyonu 13 hastada (% 44.8) intersfinkterik, 14 hastada (% 48.3)
transsfinkterik ve 2 olguda (% 6.9) suprasfinkterik fistül şeklinde idi.
Operasyon sonrası tanı referans alındığında fizik muayenenin tanı değeri %64 ve
manyetik rezonans görüntüleme için tanı değeri %82 olarak hesaplandı.

Sonuç: Manyetik rezonans görüntüleme perianal fistül,
sekonder uzantıları ve perianal apse için duyarlı ve özgül bir tanı yöntemidir.
Ayrıca manyetik rezonans inceleme perianal fistül sınıflandırmasında güvenilir
bilgiler verir.

Anahtar Kelimeler

Perianal Fistül, Manyetik Rezonans Görüntüleme, Perianal Apse

The Role of Magnetic Resonance Imaging in Determining of Perianal Fistulas

Öz

Purpose: We evaluated the
determination of perianal fistula, secondary extensions and perianal abscesses
using magnetic resonance imaging and the contribution of this to surgical
treatment.

Materials and methods:  29
patients diagnosed with perianal fistula at physical examination at the Izmir
Education Research Hospital were included in the study. Types of perianal
fistula were identified using magnetic resonance imaging. Diagnosis and the
surgical technique performed in the 29 patients operated on following magnetic
resonance imaging were assessed.

Results: Intersphincteric
fistula was determined in 14 patients (48.3%), transsphincteric fistula in 13
(44.8%) and suprasphincteric fistula in 2 (6.9%). Fistula localization using
magnetic resonance imaging was intersphincteric in 13 patients (44.8%),
transsphincteric in 14 (48.3%) and suprasphincteric in 2 (6.9%).  When postoperative diagnosis was adopted as a
reference, the diagnostic value of physical examination was calculated at 64%
and that of magnetic resonance imaging at 82%.

Conclusion: Magnetic resonance
imaging is a sensitive and specific diagnostic technique for identifying
perianal fistula, secondary extensions and perianal abscess. Magnetic resonance
imaging also provides reliable information concerning perianal fistula
classification. 

Anahtar Kelimeler

Perianal Fistulas, Magnetic Resonance Imaging, Perianal Abscesses

Kaynakça

• 1.Michalopoulos A, Papadopoulos V, Tziris N, Apostolidis S. Perianal fistulas. TechColoproctol 2010;14(1):15-17.
• 2.Buchan R, Grace RH. Anorectal suppuration: theresults of treatment and the factors influencing the recurrence rate. Br J Surg 1973;60:537–540.
• 3.Chung CC, Choi CL, Kwok SP, Leung KL, Lau WY, Li AK. Anal and perianal tuberculosis: a report of threecases in 10 years. J R CollSurgEdinb 1997;42(3):189-190.
• 4.Nordgren S, Fasth S, Hulten L. Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment. Int J ColorectalDis 1992;7(4):214-218.
• 5.Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976;63:1–12.
• 6. Halligan S, Stoker J. Imaging of fistula in ano. Radiology 2006;239:18–33.
• 7. de MiguelCriado J, del Salto LG, Rivas PF et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 2011;32(1):175-194.
• 8. Lilius HG. Fistula-in-ano, an investigation of human foetal anal ducts and intramuscular glands and a clinical study of 150 patients. ActaChirScandSuppl 1968;383:7–88
• 9. Seow-Choen, Phillips RK. Insights gained from the management of problematical anal fistulae at St. Mark’sHospital, 1984-88. Br J Surg 1991;78(5):539–541.
• 10. Obuz F. Anorektal Bölgenin Değerlendirilmesinde MRG. Turkiye Klinikleri J Radiol-Special Topics 2008;1(2):131-141.
• 11. Spencer JA, Chapple K, Wilson D, Ward J, Windsor AC, Ambrose NS. Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 1998;171:403–406.
• 12. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. AnnChirGynaecol 1984;73:219-224.
• 13. Yıldırım N, Gökalp G, Öztürk E, Zorluoğlu A, Yılmazlar T, Ercan İ, Savcı G. Ideal combination of MRI sequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experience. DiagnIntervRadiol 2012;18(1):11- 19.
• 14. Koelbel G, Schmiedl U, Majer MC, et al. Diagnosis of fistulae and sinustracts in patients with Crohn disease: value of MR imaging. AJR Am J Roentgenol 1989;152:999–1003.
• 15. Lunniss PJ, Armstrong P, Barker PG, et al. Magnetic resonance imaging of anal fistulae. Lancet 1992;340:394–396.
• 16. Beets-Tan RG, Beets GL, van der Hoop AG, et al. Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 2001;218:75–84.
• 17. Daabis N, El Shafey R, Zakaria Y, Elkhadrawy O. Magnetic resonance imaging evaluation of perianal fistula. Egypt J RadiolNuclMed 2013;44.4:705-711.
• 18. Spencer JA, Chapple K, Wilson D, Ward J, Windsor AC, Ambrose NS. Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol 1998;171:403–406.
• 19. Buchanan G, Halligan S, Williams A, Cohen CRG, Tarroni D, Phillips RK, Bartram CI. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 2002;360:1661–1662.
• 20. Buchanan GN, Halligan S, Williams AB, Cohen CRG, Tarroni D, Phillips RK, Bartram CI. Magnetic resonance imaging for primary fistula in ano. Br J Surg 2003;90:877–881