Skip to main content
Log in

Perianal sepsis: surgical perspective and practical MRI reporting for radiologists

  • Perspective
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

This article describes the development of a structured MRI reporting template and diagrammatic worksheet for perianal sepsis through collaboration between radiologists and colorectal surgeons at our institution, and the rationale behind each component of the worksheet. Benefits of this reporting worksheet include optimizing communication of key imaging findings that have a real impact on patient management, less time spent on reporting the study, and easier comparison between studies. We illustrate the utility of the report template with case studies. We summarize the current surgical approaches to perianal sepsis to help radiologists focus on reporting the findings relevant to surgical planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR (2016) Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum 59 (12):1117-1133. https://doi.org/10.1097/DCR.0000000000000733

    Article  PubMed  Google Scholar 

  2. Parks AG (1961) Pathogenesis and treatment of fistuila-in-ano. Br Med J 1 (5224):463-469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Eisenhammer S (1956) The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet 103 (4):501-506

    CAS  PubMed  Google Scholar 

  4. Abcarian H (2011) Anorectal infection: abscess-fistula. Clin Colon Rectal Surg 24 (1):14-21. https://doi.org/10.1055/s-0031-1272819

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gosselink MP, van Onkelen RS, Schouten WR (2015) The cryptoglandular theory revisited. Colorectal Dis 17 (12):1041-1043. https://doi.org/10.1111/codi.13161

    Article  PubMed  Google Scholar 

  6. Sainio P (1984) Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 73 (4):219-224

    CAS  PubMed  Google Scholar 

  7. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, Garcia-Olmo D (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis 22 (12):1459-1462. https://doi.org/10.1007/s00384-007-0334-7

    Article  PubMed  Google Scholar 

  8. Hellers G, Bergstrand O, Ewerth S, Holmstrom B (1980) Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 21 (6):525-527

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Schwartz DA, Loftus EV, Jr., Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, Sandborn WJ (2002) The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 122 (4):875-880

    Article  PubMed  Google Scholar 

  10. Beets-Tan RG, Beets GL, van der Hoop AG, Kessels AG, Vliegen RF, Baeten CG, van Engelshoven JM (2001) Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology 218 (1):75-84. https://doi.org/10.1148/radiology.218.1.r01dc0575

    Article  CAS  PubMed  Google Scholar 

  11. Wise PE, Schwartz DA (2012) The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin North Am 41 (2):379-391. https://doi.org/10.1016/j.gtc.2012.01.009

    Article  PubMed  Google Scholar 

  12. Buchanan G, Halligan S, Williams A, Cohen CR, Tarroni D, Phillips RK, Bartram CI (2002) Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 360 (9346):1661-1662. https://doi.org/10.1016/S0140-6736(02)11605-9

    Article  PubMed  Google Scholar 

  13. Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreno O, Espi A, Puchades I, Garcia-Granero E (2014) Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Colorectal Dis 29 (12):1557-1564. https://doi.org/10.1007/s00384-014-2028-2

    Article  PubMed  Google Scholar 

  14. Sahni VA, Ahmad R, Burling D (2008) Which method is best for imaging of perianal fistula? Abdom Imaging 33 (1):26-30. https://doi.org/10.1007/s00261-007-9309-y

    Article  PubMed  Google Scholar 

  15. Erden A (2018) MRI of anal canal: normal anatomy, imaging protocol, and perianal fistulas: Part 1. Abdom Radiol (NY) 43 (6):1334-1352. https://doi.org/10.1007/s00261-017-1305-2

    Article  Google Scholar 

  16. Gallego JC, Echarri A (2018) Role of magnetic resonance imaging in the management of perianal Crohn's disease. Insights Imaging 9 (1):47-58. https://doi.org/10.1007/s13244-017-0579-9

    Article  PubMed  Google Scholar 

  17. Sheedy SP, Bruining DH, Dozois EJ, Faubion WA, Fletcher JG (2017) MR Imaging of Perianal Crohn Disease. Radiology 282 (3):628-645. https://doi.org/10.1148/radiol.2016151491

    Article  PubMed  Google Scholar 

  18. VanBuren WM, Lightner AL, Kim ST, Sheedy SP, Woolever MC, Menias CO, Fletcher JG (2018) Imaging and Surgical Management of Anorectal Vaginal Fistulas. Radiographics 38 (5):1385-1401. https://doi.org/10.1148/rg.2018170167

    Article  PubMed  Google Scholar 

  19. Hori M, Oto A, Orrin S, Suzuki K, Baron RL (2009) Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano. J Magn Reson Imaging 30 (5):1021-1026. https://doi.org/10.1002/jmri.21934

    Article  PubMed  Google Scholar 

  20. Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P (2016) Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 44 (6):1381-1396. https://doi.org/10.1002/jmri.25325

    Article  PubMed  Google Scholar 

  21. Abd-El Khalek Abd AA, Fahmy DM (2018) Diagnostic Value of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient in Assessment of the Activity of Crohn Disease: 1.5 or 3 T. J Comput Assist Tomogr 42 (5):688-696. J Comput Assist Tomogr 42 (5):688-696. https://doi.org/10.1097/rct.0000000000000754

  22. Van Assche G, Vanbeckevoort D, Bielen D, Coremans G, Aerden I, Noman M, D'Hoore A, Penninckx F, Marchal G, Cornillie F, Rutgeerts P (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn's disease. Am J Gastroenterol 98 (2):332-339. https://doi.org/10.1111/j.1572-0241.2003.07241.x

    Article  PubMed  Google Scholar 

  23. Pariente B, Mary JY, Danese S, Chowers Y, De Cruz P, D'Haens G, Loftus EV, Jr., Louis E, Panes J, Scholmerich J, Schreiber S, Vecchi M, Branche J, Bruining D, Fiorino G, Herzog M, Kamm MA, Klein A, Lewin M, Meunier P, Ordas I, Strauch U, Tontini GE, Zagdanski AM, Bonifacio C, Rimola J, Nachury M, Leroy C, Sandborn W, Colombel JF, Cosnes J (2015) Development of the Lemann index to assess digestive tract damage in patients with Crohn's disease. Gastroenterology 148 (1):52-63. https://doi.org/10.1053/j.gastro.2014.09.015

    Article  PubMed  Google Scholar 

  24. Irvine EJ (1995) Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol 20 (1):27-32

    Article  CAS  PubMed  Google Scholar 

  25. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63 (1):1-12

    Article  CAS  PubMed  Google Scholar 

  26. Marks CG, Ritchie JK (1977) Anal fistulas at St Mark's Hospital. Br J Surg 64 (2):84-91

    Article  CAS  PubMed  Google Scholar 

  27. Rizzo JA, Naig AL, Johnson EK (2010) Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am 90 (1):45-68, Table of Contents. https://doi.org/10.1016/j.suc.2009.10.001

  28. Abcarian H (2014) Anal fistula : principles and management. Springer, New York

    Book  Google Scholar 

  29. Hussain SM, Outwater EK, Joekes EC, Ulrich F, Delemarre HB, Bemelman WA, Li X, Mitchell DG (2000) Clinical and MR imaging features of cryptoglandular and Crohn's fistulas and abscesses. Abdom Imaging 25 (1):67-74

    Article  CAS  PubMed  Google Scholar 

  30. Lewis RT, Maron DJ (2010) Anorectal Crohn's disease. Surg Clin North Am 90 (1):83-97, Table of Contents. https://doi.org/10.1016/j.suc.2009.09.004

  31. van Koperen PJ, Safiruddin F, Bemelman WA, Slors JF (2009) Outcome of surgical treatment for fistula in ano in Crohn's disease. Br J Surg 96 (6):675-679. https://doi.org/10.1002/bjs.6608

    Article  PubMed  Google Scholar 

  32. Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239 (1):18-33. https://doi.org/10.1148/radiol.2391041043

    Article  PubMed  Google Scholar 

  33. Cuiñas K, Williams J (2015) PTU-196 Goodsall’s rule – past its sell-by date? Gut 64:A149-A149

    Article  Google Scholar 

  34. Cirocco WC, Reilly JC (1992) Challenging the predictive accuracy of Goodsall's rule for anal fistulas. Dis Colon Rectum 35 (6):537-542

    Article  CAS  PubMed  Google Scholar 

  35. de Miguel Criado J, del Salto LG, Rivas PF, del Hoyo LF, Velasco LG, de las Vacas MI, Marco Sanz AG, Paradela MM, Moreno EF (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 32 (1):175-194. https://doi.org/10.1148/rg.321115040

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edwin Ho.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethics standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ho, E., Rickard, M.J.F.X., Suen, M. et al. Perianal sepsis: surgical perspective and practical MRI reporting for radiologists. Abdom Radiol 44, 1744–1755 (2019). https://doi.org/10.1007/s00261-019-01920-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-01920-9

Keywords

Navigation