Effectiveness of a three-dimensional anorectal ultrasound in perianal Crohn’s disease: incompatibility with clinical and surgical examinations
- 246 Downloads
We have correlated the 3D anorectal ultrasound (3D ARU) findings with clinical examination and the surgical findings and examined its capacity to provide ancillary information, which potentially alters patient management.
Patients and methods
This is a prospective analysis conducted at a tertiary academic hospital. A total of 95 patients were included. We screened for sphincter defects and the presence of perianal Crohn’s disease (PACD)-related lesions.
We performed 150 3D ARUs. Exploratory ultrasound coincided with the rationale for diagnosis in 67.7 % of cases, and fistulae were detected in 79 % of cases where there was clinical suspicion. Fistulae were associated with abscesses in 29 cases, and isolated abscesses were identified in 19 cases (17.7 %), only 12 of which (63.2 %) were clinically suspected. Sphincter defects were observed in 15 cases with 7 cases (77.8 %) presenting with clinical fecal incontinence. The operative findings coincided with ultrasonographic findings in 81.3 % of the analyzed cases. The inter-observer variability of endosonographic classification resulted in a kappa score of 0.86. Ultrasonographic data altered the therapeutic plan of management in 73 cases (48.6 %).
Three-dimensional ARU is accurate in the diagnosis of fistula type in PACD and in the delineation of ancillary suspected and unsuspected abscess collections. Its use impacts therapeutic management in about half the cases examined. A new ultrasonographic-based PACD classification system is presented which has high inter-observer agreement but which requires future prospective validation in clinical PACD patients.
KeywordsEndoanal ultrasound Perianal Crohn’s disease Fistulae
We thank Dr. A Zbard for his help in the final revision of the paper.
Conflict of interest
No conflict of interest.
Contribution of authors
Fernando de la Portilla was responsible for the conception and design of the study. He acquired, analyzed, and interpreted the data and drafted the manuscript and was responsible for revising the manuscript critically for important intellectual content.
V Durán, MV Maestre, JM Díaz-Pavón, JM Vázquez-Monchul, C Palacios, JL Gollonet, and JM Sánchez-Gil contributed to the conception and design of the study.
All authors gave their approval of the final version to be published.
- 9.Yousem DM, Frisman EK, Jones B (1988) Crohn’s disease, perirectal and perianal findings at CT. Radiology 167:394–396Google Scholar
- 10.Mulder C, Tio T, Tytgat G (1988) Transrectal ultrasonography in the assessment of perianal fistula and/or abscess in Crohn’s disease. Gastroenterology 94:A313Google Scholar
- 13.Shajej M, Bongers H, Aicher H, Weihlich M, Starlinger M, Jenss H (1992) Value of MR tomography in perineal Crohn’s disease: a prospective study. Gastroenterology 102(Supl. A):697Google Scholar
- 18.Schwartz DA, Wiersema MJ, Dudiak KM, Fletcher JG, Clain JE, Tremaine WJ, Zinsmeister AR, Norton ID, Boardman LA, Devine RM, Wolff BG, Young-Fadok TM, Diehl NN, Pemberton JH, Sandborn WJ (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 121:1064–1072CrossRefPubMedGoogle Scholar