The Value of MRI in Preoperative assessment of Perianal fistula

1Abdulmalik A.Qais,1Ibrahim A. Almahbashi, 2Mohammed A. Essa, 3WaheebAlqubati

1 Associate Professor, Radiology departPment, Faculty of medicine, Sana'a university

2 Associate Professor Surgical departement, Faculty of medicine, Sana'a university

3consultant surgeon, Althawra general modern hospital –Sana'a

Introduction:

Perianal fistula is an important disorder that has a tendency to recur despite seemingly appropriate surgery. Recurrence is usually caused by infection that was missed during surgery. In addition, complex fistulous track that have complicated course, with secondary extension, and horseshoe fistula or ischiorectal abscesses are often associated with recurrence(1). Thus, accurate preoperative assessment of anatomy, extension and classification of perianal fistulas is crucial for successful treatment. The traditional contrast material-enhanced conventional fistulography has low accuracy of about 16%because mainly of two disadvantages. First, the primary tract and its extension do not fill with contrast if they are plugged with pus or debris and, second, the sphincteric muscle

anatomy is not imaged and thus relation between tract and internal-external sphincters is not depicted (2). Transrectal US better shows fistula and its relation to the anal sphincteric muscles, but it has a limited field of view and absence of coronal planes of imaging (3). CT fistulography usually fails to depict subtle fistulous tract because of similar attenuation values of fistulous tract, sphinctric muscles and fibrosis (4). However, the recent studies have reported that MRI can provide preoperative information of peri anal fistulas better than any diagnostic modality (5,6,7,8). In this study we will describe the value of MRI in preoperative assessment of the perianal fistulas regarding recent fistulous classifications in AlthawrahGeneral Hospital, Sanaa in an adequate number of Yemeni patients.

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An Academic Biannual Refereed Journal, Published by Sana'a University

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