Anal fistula ultrasound assessment (comparison of conventional and intracavitary contrast-enhanced endorectal ultrasound)

Objective: To compare conventional endorectal ultrasound and intracavitary contrast-enhanced endorectal ultrasound in the assessment of fistulous tract topography in patients with anal fistula. Material and methods: A total of 49 patients with anal fistula (34 (69.4%) men and 15 (30.6%) women) aged 27-54 years (41.2 ± 13.8 years (M ± σ)) were examined. All patients underwent various surgical procedures. Endorectal ultrasound (conventional and with intracavitary using 1.5% hydrogen peroxide solution) was performed by the same doctor with use of Hi Vision Preirus ultrasound system (Hitachi, Japan) with 5-10 MHz intracavitary linear transducer. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endorectal ultrasound with intracavitary using 1.5% hydrogen peroxide solution in purulent cavity detecting are 95.2, 71.4, 95.2, 71.4, and 91.8% versus 76.2, 57.1, 91.4, 28.6, and 73.5%, respectively in conventional endorectal ultrasound. In detection of internal fistula opening and determination of its localization no significant differences were found between two types of endorectal ultrasound (conventional and with intracavitary using 1.5% hydrogen peroxide solution) as well as in determining the type of anal fistula in relation to external sphincter and its relationship with portions of external sphincter (in trans-sphincter fistulas cases) (P > 0.05). However, sensitivity of detection of superficial and deep external sphincter portions involvement during intracavitary contrast-enhanced endorectal ultrasound increased to 100.0% (from 66.7 and 71.4%, respectively). Conclusion: Study results show feasibility of using intracavitary contrast-enhanced endorectal ultrasound in assessing of anal fistula topography in difficult diagnostic cases.

conventional endorectal ultrasound, intracavitary contrast-enhanced endorectal ultrasound, anal fistula (fistula-in-ano), internal fistula orifice (opening), external (cutaneous) fistula orifice (opening)

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