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Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the accuracy of tridimensional endoanal ultrasound (3D-EAUS) in the diagnosis of perianal sepsis comparing the results with the surgical findings, considered as reference standard.

Methods

From January 2009 to January 2013, all the patients referred for the assessment and treatment of perianal sepsis with suspected anorectal origin were enrolled in the study. All patients gave informed written consent. Prior to surgery, all the patients underwent anamnestic evaluation, clinical examination, and unenhanced and H2O2-enhanced 3D-EAUS. Surgery was performed by a colorectal surgeon blinded to the 3D-EAUS results.

Results

A total of 212 patients with suspected perianal suppurations were assessed during the study period. In 12 patients, the H2O2-enhanced 3D-EAUS was not performed, and so, they were excluded from the study. Very good agreement between 3D-EAUS and examination under anesthesia (EUA) in the classification of primary fistula tracts (kappa = 0.93) and in the identification of fistula internal opening (kappa = 0.97) was found. There was a good concordance (kappa = 0.71) between 3D-EAUS and surgery in the detection of fistula secondary extensions. The overall sensitivity and specificity of 3D-EAUS in the diagnosis of perianal sepsis were 98.3 and 91.3 % respectively.

Conclusion

3D-EAUS is a safe and reliable technique in the assessment of perianal sepsis. It may assist the surgeon in delineating the fistula tract anatomy and in determining the origin of sepsis, supporting the preoperative planning of definitive and appropriate surgical therapy.

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References

  1. Rottenberg GT, Williams AB (2002) Endoanal ultrasound. Br J Radiol 75(893):482–8. doi:10.1259/bjr.75.893.750482

    Article  CAS  PubMed  Google Scholar 

  2. Deen KI, Williams JG, Hutchinson R, Keighley MR, Kumar D (1994) Fistulas in ano: endoanal ultrasonographic assessment assists decision making for surgery. Gut 35(3):391–4

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Brunese L, Amitrano M, Gargano V, Vallone G, Grassi R, Rotondo A, Smaltino F (1996) [Anal endosonography: the study technic and the correlations between the normal and echographic anatomy] Radiol Med 91(3):253–7

  4. Marano I, Grassi R, Donnianni T, Gargano V, Fanucci A, Romano G, Pellecchia L, Rotondano G (1996) CT and anal endosonography in the evaluation of electrically stimulated neoanal sphincter: a preliminary report. Abdom Imaging 21(4):353–6

  5. Brunese L, Amitrano M, Gargano V, Pinto A, Vallone G, Grassi R, Rotondo A, Smaltino F (1996) [Role of anal endosonography in inflammation and trauma of the anal canal] Radiol Med 92(6):742–7

  6. Grassi R, Rotondo A, Catalano O, Amitrano M, Vallone G, Gargano V, Fanucci A (1995) [Endoanal ultrasonography, defecography, and enema of the colon in the radiologic study of incontinence] Radiol Med 89(6):792–7

  7. Kim Y, Park YJ (2009) Three-dimensional endoanal ultrasonographic assessment of an anal fistula with and without H(2)O(2) enhancement. World J Gastroenterol 15(38):4810–5

  8. Reginelli A, Mandato Y, Cavaliere C, Pizza NL, Russo A, Cappabianca S, Brunese L, Rotondo A, Grassi R (2012) Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol Med 117(5):759–71. doi:10.1007/s11547-011-0768-4

  9. Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR (2004) Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233(3):674–81. doi:10.1148/radiol.2333031724

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Cho DY (1999) Endosonographic criteria for an internal opening of fistula-in-ano. Dis Colon Rectum 42(4):515–8

    Article  CAS  PubMed  Google Scholar 

  12. 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 

  13. Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, Varma JS, George BD (2007) The treatment of anal fistula: ACPGBI position statement. Colorectal Dis 9(Suppl 4):18–50. doi:10.1111/j.1463-1318.2007.01372.x

    Article  PubMed  Google Scholar 

  14. Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB (2005) Endoanal ultrasound-guided surgery for anal fistula. Endoscopy 37(8):722–8. doi:10.1055/s-2005-870155

    Article  CAS  PubMed  Google Scholar 

  15. Abou-Zeid AA (2011) Anal fistula: intraoperative difficulties and unexpected findings. World J Gastroenterol 17(28):3272–6. doi:10.3748/wjg.v17.i28.3272

    Article  PubMed Central  PubMed  Google Scholar 

  16. Murad-Regadas SM, Regadas FS, Rodrigues LV, Holanda Ede C, Barreto RG, Oliveira L (2010) The role of 3-dimensional anorectal ultrasonography in the assessment of anterior transsphincteric fistula. Dis Colon Rectum 53(7):1035–40. doi:10.1007/DCR.0b013e3181dce163

    Article  PubMed  Google Scholar 

  17. Garcés-Albir M, García-Botello SA, Esclapez-Valero P, Sanahuja-Santafé A, Raga-Vázquez J, Espi-Macías A, Ortega-Serrano J (2012) Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis 27(8):1109–16. doi:10.1007/s00384-012-1437-3, Epub 2012 Mar 16

    Article  PubMed  Google Scholar 

  18. Murad-Regadas SM, Regadas FS, Rodrigues LV, Fernandes GO, Buchen G, Kenmoti VT, Soares Gdos S, Holanda EC (2011) Anatomic characteristics of anal fistula on three-dimensional anorectal ultrasonography. Dis Colon Rectum 54(4):460–6. doi:10.1007/DCR.0b013e3182060c84

    Article  PubMed  Google Scholar 

  19. Subasinghe D, Samarasekera DN (2010) Comparison of preoperative endoanal ultrasonography with intraoperative findings for fistula in ano. World J Surg 34(5):1123–7. doi:10.1007/s00268-010-0478-4

    Article  PubMed  Google Scholar 

  20. Santoro GA, Fortling B (2007) The advantages of volume rendering in three-dimensional endosonography of the anorectum. Dis Colon Rectum 50(3):359–68. doi:10.1007/s10350-006-0767-z

    Article  PubMed  Google Scholar 

  21. Tilney HS, Heriot AG, Trickett JP, Massouh H, Edwards DP, Mellor SG Gudgeon AM (2006) The use of intra-operative endo-anal ultrasound in perianal disease. Colorectal Dis 8(4):338–41. doi:10.1111/j.1463-1318.2006.00927.x

  22. Felt-Bersma RJ (2006) Endoanal ultrasound in perianal fistulas and abscesses. Dig Liver Dis 38(8):537–43. doi:10.1016/j.dld.2006.02.016

    Article  CAS  PubMed  Google Scholar 

  23. Lengyel AJ, Hurst NG, Williams JG (2002) Pre-operative assessment of anal fistulas using endoanal ultrasound. Colorectal Dis 4(6):436–40

    Article  CAS  PubMed  Google Scholar 

  24. Moscowitz I, Baig MK, Nogueras JJ, Ovalioglu E, Weiss EG, Singh JJ, Wexner SD (2003) Accuracy of hydrogen peroxide enhanced endoanal ultrasonography in assessment of the internal opening of an anal fistula complex. Tech Coloproctol 7(3):133–7. doi:10.1007/s10151-003-0024-6

    Article  CAS  PubMed  Google Scholar 

  25. Ratto C, Gentile E, Merico M, Spinazzola C, Mangini G, Sofo L, Doglietto G (2000) How can the assessment of fistula-in-ano be improved? Dis Colon Rectum 43(10):1375–82

    Article  CAS  PubMed  Google Scholar 

  26. Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A, Athanasiou T (2012) Phillips RK A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 55(5):576–85. doi:10.1097/DCR.0b013e318249d26c

    Article  PubMed  Google Scholar 

  27. Sun MR, Smith MP, Kane RA (2008) Current techniques in imaging of fistula in ano: three-dimensional endoanal ultrasound and magnetic resonance imaging. Semin Ultrasound CT MR 29(6):454–71

    Article  PubMed  Google Scholar 

  28. West RL, Dwarkasing S, Felt-Bersma RJ, Schouten WR, Hop WC, Hussain SM, Kuipers EJ (2004) Hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in evaluating perianal fistulas: agreement and patient preference. Eur J Gastroenterol Hepatol 16(12):1319–24

    Article  PubMed  Google Scholar 

  29. West RL, Zimmerman DD, Dwarkasing S, Hussain SM, Hop WC, Schouten WR, Kuipers EJ, Felt-Bersma RJ (2003) Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum 46(10):1407–15. doi:10.1097/01.DCR.0000089112.99927.60

    Article  CAS  PubMed  Google Scholar 

  30. Gustafsson UM, Kahvecioglu B, Aström G, Ahlström H, Graf W (2001) Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study. Colorectal Dis 3(3):189–97

    Article  CAS  PubMed  Google Scholar 

  31. Sabir N, Sungurtekin U, Erdem E, Nessar M (2000) Magnetic resonance imaging with rectal Gd-DTPA: new tool for the diagnosis of perianal fistula. Int J Colorectal Dis 15(5–6):317–22

    Article  CAS  PubMed  Google Scholar 

  32. Scholefield JH, Berry DP, Armitage NC, Wastie ML (1997) Magnetic resonance imaging in the management of fistula in ano. Int J Colorectal Dis 12(5):276–9

    Article  CAS  PubMed  Google Scholar 

  33. Solomon MJ (1996) Fistulae and abscesses in symptomatic perianal Crohn’s disease. Int J Colorectal Dis 11(5):222–6

    Article  CAS  PubMed  Google Scholar 

  34. Faggian A, Muto M, Pizza NL, Iasiello F, Iacobellis F, Berritto D, Gatta G, DI Grezia G, Serra N, Grassi R (2014) [Role of three dimensional endoanal ultrasound and MRI in the assessment of perianal fistulas] Il giornale italiano di Radiologia Medica 1:955–960

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    Authors and Affiliations

    1. Emergency Department “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

      Antonio Brillantino & Fiorella Paladino

    2. “Villa delle Querce” Hospital, Via Battistello Caracciolo 48, 80136, Naples, Italy

      Antonio Brillantino, Giandomenico Di Sarno, Francesco D’Aniello & Adolfo Renzi

    3. Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

      Francesca Iacobellis & Roberto Grassi

    4. “Mediterranea” Hospital, Via Orazio, 2, 80122, Naples, Italy

      Domenico Izzo

    5. Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

      Maurizio De Palma & Maurizio Castriconi

    6. VIII Department of General and Gastrointestinal Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

      Natale Di Martino

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    1. Antonio Brillantino
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    Correspondence to Francesca Iacobellis.

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    Antonio Brillantino and Francesca Iacobellis contributed equally to this work.

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    Brillantino, A., Iacobellis, F., Di Sarno, G. et al. Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis 30, 535–542 (2015). https://doi.org/10.1007/s00384-015-2167-0

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    • DOI: https://doi.org/10.1007/s00384-015-2167-0

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