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Ultrasound Study of Anal Fistulas With Hydrogen Peroxide Enhancement

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Diseases of the Colon & Rectum

PURPOSE: This study was designed to evaluate the effectiveness of hydrogen peroxide-enhanced, endoanal ultrasound in the assessment of fistula-in-ano and compare ultrasonographic results with the surgical outcome. METHODS: A total of 80 patients with anal fistula were studied prospectively by physical examination and endoanal ultrasound enhanced with hydrogen peroxide. We used standarized ultrasonography and operation notes. The results of these studies were compared with the surgical findings. The ultrasonographic study of the anal canal describes the fistula’s characteristics, which provides an ultrasonographic classification of the fistula. All endoanal ultrasounds were performed by colorectal surgeons. RESULTS: In 94 percent of the cases, the internal opening was identified. In only one case were we unable to obtain sufficient information about the tract and the fistula’s level. The endoanal ultrasound was able to correctly identify whether the tract was linear or curvilinear in 95 percent of the cases. The ultrasound level coincided with surgical findings in 85 percent of patients, and chronic fistula cavities were confirmed by surgery in 75 percent of patients. CONCLUSIONS: The use of endoanal ultrasound, with hydrogen peroxide enhancement, by a colorectal surgeon with adequate experience in endoanal ultrasound provides excellent results in the presurgical examination of fistula-in-ano.

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REFERENCES

  1. Marks CG, Ritchie JK. Anal fistulas at St Mark’s Hospital. Br J Surg 1977;64:84-91

    Google Scholar 

  2. Lunniss PJ, Kamm MA, Phillips RK. Factors affecting continence in fistula surgery. Br J Surg 1994;81:1382-5

    Google Scholar 

  3. Parks AG. Pathogenesis and treatment of fistula-in-ano. BMJ 1961;1:463-9

    Google Scholar 

  4. Kuijpers HC, Schulpen T. Fistulography for fistula-in-ano: is it useful? Dis Col Rectum 1985;28:103-4

    Google Scholar 

  5. Schratter SA, Lochs H, Vogelsang S, Schurawitzki H, Herold C, Schratter M. Endoscopic ultrasonography versus computed tomography in the differential diagnosis of perianorectal complications in Crohn’s disease. Endoscopy 1993;25:582-6

    Google Scholar 

  6. Lunniss PJ, Barker PG, Sultan AH, et al. Magnetic resonance imaging of fistula-in-ano. Dis Colon Rectum 1994;37:708-18

    Google Scholar 

  7. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluating of Crohn’s perianal fistulas. Gastroenterology 2001;121:1064-72

    Google Scholar 

  8. Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease. Br J Surg 1999;86:360-4

    Google Scholar 

  9. Milson JW, Lavery IC, Stolfi VM, et al. The expanding utility of endoluminal ultrasonography in the management of rectal cancer. Surgery 1992;112:832-41

    Google Scholar 

  10. Navarro A, Marco C. Endoluminal ultrasound in the assessment of rectal cancer. Rev Esp Enf Digest 1996;88:661-6

    Google Scholar 

  11. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg 2000;24:208-15

    Google Scholar 

  12. Law PJ, Talbot RW, Bartram CI, Northover JM. Anal endosonography in the evaluation of perianal sepsis and fistula-in-ano. Br J Surg 1989;76:752-5

    Google Scholar 

  13. Cuesta MA, Meijer S, Derksen EJ, Boutkan H, Meuwissen SG. Anal sphincter imaging in fecal incontinence using endosonography. Dis Colon Rectum 1992;35:59-63

    Google Scholar 

  14. Cheong DM, Nogueras JJ, Wexner SD, Jagelman DG. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum 1993;36:1158-60

    Google Scholar 

  15. Poen AC, Felt-Bersma RJ, Eijsbouts QA, Cuesta MA, Meuwissen SG. Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum 1998;41:1147-52

    Google Scholar 

  16. Kruskal JB, Kane RA, Morrin MM. Peroxide enhanced anal endosonography: technique image interpretation, and clinical applications. Radiographics 2001;21:S173-89

    Google Scholar 

  17. Tjandra JJ, Milsom JW, Stolfi VM, et al. Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor. Dis Colon Rectum 1992;35:465-70

    Google Scholar 

  18. Senagore AJ. Intrarectal and intraanal ultrasonography in the evaluation of colorectal pathology. Surg Clin North Am 1994;74:1465-72

    Google Scholar 

  19. Sultan AH, Nicolls RJ, Kamm MA, Hudson CN, Beynon J, Bartram CI. Anal endosonography and correlation with in vitro and in vivo anatomy. Br J Surg 1993;80:508-11

    Google Scholar 

  20. Choen S, Burnett S, Bartram CI, Nicholls RJ. A comparison between endoanal ultrasound and digital examination in anal fistulae. Br J Surg 1991;78:445-7

    Google Scholar 

  21. Williams JG. Anal ultrasonography in the diagnosis and management of abscess and fistula disease of the anorectum. Semin Colon Rectal Surg 1995;2:105-13

    Google Scholar 

  22. Tio TL, Mulder CJ, Wijers OB, Sars PR, Tytgat GN. Endosonography of peri-anal and peri-colorectal fistula and/or abscess in Crohn ‘s disease. Gastrointest Endosc 1990;36:331-6

    Google Scholar 

  23. El Mouaaouy A, Tolksdorf A, Starlinger M, Becker HD. Endoscopic sonography of the anorectum in inflamatory rectal diseases. Gastroenterology 1992;30:486-94

    Google Scholar 

  24. Piccinini EE, Rosati G, Ugolini G, Marroccu S, Del Governatore M, Conti A. Transanal ultrasonography in the study of fistulas and perianal abscess. Minerva Chir 1996;54:653-9

    Google Scholar 

  25. Cataldo PA, Senagore A, Luchtefeld MA. Intrarectal ultrasound in the evaluation of perirectal abscesses. Dis Colon Rectum 1993;36:554-8

    Google Scholar 

  26. Stoker J, Hussain SM, Laméris JS. Endoanal magnetic resonance imaging versus endosonography. Radiol Med 1996;92:738-41

    Google Scholar 

  27. Hussain SM, Stoker J, Schouten WR, Hop WCJ, Laméris JS. Fistula-in-ano: endoanal sonography verus endoanal MR imaging in classification. Radiology 1996;200:475-81

    Google Scholar 

  28. Ratto C, Gentile E, Merico M, et al. How can the assessment of fistula-in-ano be improved? Dis Colon Rectum 2000;43:1375-82

    Google Scholar 

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Acknowledgment

The authors thank Mr. Andrew Maguire for helping with the preparation of the manuscript.

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Authors and Affiliations

  1. Colorectal Unit, General Surgery Department, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain

    Alberto Navarro-Luna M.D., MªIsabel García-Domingo M.D., Josep Rius-Macías M.D. & Constancio Marco-Molina M.D.

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  1. Alberto Navarro-Luna M.D.
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  2. MªIsabel García-Domingo M.D.
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  3. Josep Rius-Macías M.D.
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Correspondence to Alberto Navarro-Luna M.D..

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Navarro-Luna, A., García-Domingo, M., Rius-Macías, J. et al. Ultrasound Study of Anal Fistulas With Hydrogen Peroxide Enhancement. Dis Colon Rect 47, 108–114 (2004). https://doi.org/10.1007/s10350-003-0015-8

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  • DOI: https://doi.org/10.1007/s10350-003-0015-8

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