Clinical Correlation and MRI Finding in the Management of Fistula in Ano

Fistula is considered to be any abnormal passage which connects two epithelial surfaces. Parks fistula classification demonstrates the biggest practical significance and divides fistulae into inter-sphincteric, trans-sphincteric, supra-sphincteric, and extra-sphincteric. Diagnostic method options are retrograde (RTG) fistulography, computed tomography (CT) fistulography, and magnetic resonance imaging (MRI) of pelvic organs. The purpose of the study is to correlate clinical examination and operative findings with the findings of MRI and to draw efficacy of MRI as a preoperative diagnostic tool in the management of fistula in ano. This study was performed at the Surgery Department and MRI unit of the Radiology Department of JLNH and RC, Bhilai, from January 2014 to July 2015. Patients with perianal fistulae were included in our prospective study. All patients underwent high-spatial resolution MR imaging. MR imaging findings were correlated with the intraoperative surgical finding. MR imaging shows 7 fistulous patients with side branching and 16 with abscess cavity which was 100% intraoperatively correlated. Fifty-six patients out of 60 completely correlated with MRI for primary track which was clinically significant. MRI had 96% sensitivity and 100% specificity for primary tract and internal opening and 100% sensitivity and specificity for abscess and multiple tracks. MRI is useful in successful treatment of perianal fistulae by providing more accurate anatomical information about the amount of sphincter above the track and the position and level of the internal opening, thereby increasing the likelihood of successful surgical treatment. So, MRI is the very important preoperative investigation tool for fistula in ano.