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Presentation2.pptx peri anal fistula

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Transcript

  • 1. MRI Imaging of Peri-anal Fistula. Dr. Abd Allah Nazeer. MD.
  • 2. Normal MR anatomy of the anal canal
  • 3. Grade 1 Simple Inter-sphincteric Fistula
  • 4. Grade 2 Inter-sphincteric track with secondary track or abscess
  • 5. Grade 3 Trans-sphincteric Fistula
  • 6. Grade 4 Trans-sphincteric Fistula With Abscess or Secondary Track
  • 7. Grade 5 Supralevator and Translevator Disease
  • 8. Majority (50%) of patients with idiopathic peri-anal fistulation have uncomplicated disease 25% have trans-sphincteric fistulae complicated by secondary tracks or ischiorectal abscess Supra-levator or trans-levator disease is relatively rare in this patient group (8%).
  • 9. Grade 1- Intersphincteric fistula.
  • 10. Grade 1- Intersphincteric fistula.
  • 11. Axial T2-weighted images with fat suppression (STIR) at two different levels (a, b). The dotted arrows demonstrate the inter-sphincteric fistula and its extension to the skin (solid arrow)
  • 12. Grade 1- Intersphincteric fistula.
  • 13. Grade 1- Intersphincteric fistula.
  • 14. Grade 2- Inter-sphincteric fistula with collection or secondary tract.
  • 15. Grade 3- Trans-sphincteric fistula.
  • 16. Grade 3- Trans- sphincteric fistula.
  • 17. Grade 3- Trans- sphincteric fistula.
  • 18. Grade 3- Trans- sphincteric fistula.
  • 19. Grade 3- Trans- sphincteric fistula.
  • 20. Grade 3- Trans-sphincteric fistula.
  • 21. Grade 4- Trans-sphincteric fistula with secondary track or abscess formation.
  • 22. Grade 4- Trans-sphincteric fistula.
  • 23. Trans-sphenteric fistula with abscess formation.
  • 24. Trans-sphenteric fistula with abscess formation.
  • 25. Grade 5- Translevator disease.
  • 26. Grade 5- Translevator disease.
  • 27. Grade 5 : supralevator & translevator fistula
  • 28. Left supra-levator abscess with inflammatory changes at the left obturator muscle and extension to the ischiorectal fossa.
  • 29. Complex fistula
  • 30. Horseshoe fistula with abscess formation at ischio-rectal and ischio-anal fossa.
  • 31. Differential diagnosis Sinus pilonidalis On the left an example of a sinus pilonidalis. There is a small abscess just above the nates. There is no relation with the sphincter complex.
  • 32. Proctitis On the left images of a patient who presented with anal complaints. No fistula was seen. There is, however, a diffuse thickening of the rectal mucosa due to a proctitis.
  • 33. Abscess in the Ischioanal space An abscess in the ischioanal space with no connection to the sphincter complex