Fistula in ano

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Fistula in ano

  1. 1. FISTULA IN ANO – PERIANAL FISTULA<br />18 YR MALE PATIENT WITH H/O TRAUMA OVER ANAL VERGE REGION – PRESENTLY UNDER ASSESMENT FOR PERIANAL FISTULA’S. <br />PRESENT CASE – GRADE ONE INTERSPHICTERIC FISTULOUS TRACTS <br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C CHANDIGARH<br />MERCURY IMAGING CENTRE <br />SCO 16-17 SEC 20D CHANDIGARH<br />
  2. 2. Frederick Salmon<br />STARTED 'The Infirmary for the Relief of the Poor afflicted with Fistula and other Diseases of the Rectum'.<br />PERFORMED 3500 OPERATIONS WITH NOT EVEN SINGLE FATALITY.<br />BENEVOLENT DISPENSARY TOST MARK’S HOSPITAL LONDON<br />
  3. 3. ANATOMY <br />LEVATOR SLING<br />ISCHIO RECTAL FOSSA<br />ISCHIOANAL FOSSA<br />
  4. 4. IMPORTANT POINTS<br /> EXTERNAL ANAL SPHINCTER <br />INTERNAL ANAL SPINCHTER<br />Voluntary control<br />Similar in signal to levator sling <br />15% of the anal tone.<br />Straited muscle – continous with the puborectalis / levator muscle<br />Involuntary Control<br />Smooth Muscle Responsible For 85 % Of The Anal Tone.<br />Continous With Circular Smooth Muscle Of The Rectum.<br />Similar In Signal To Anal Musculature<br />Relatively Hyperintense On Fat Sat Sequences. <br />
  5. 5. IMPORTANT POINTS<br /> ANAL CLOCK <br /> TRANSVERSE ANAL LINE <br />Define the cutaneous opening (Predicts the internal opening) <br />LITHOTOMY POSITION<br />DEFINE THE INTERNAL OPENING <br />12”o clock – Anterior perineum<br /> 3“O CLOCK - Left Lateral aspect<br />6 ‘ o clock - Natal cleft<br /> 9 ‘ o clock – Rt side of the perineum <br />
  6. 6. CUTANEOUS OPENING<br />Rt side – Posterior to the anal canal <br />Lt side – Posterior to the anal canal<br />
  7. 7. TRACT <br />Rt side – linear longitudinal tract with no secondary ramifications –present in the intersphincteric plane<br />Left side – linear longitudinal with no seconday ramifications- present in the intersphincteric plane<br />
  8. 8. INTERNAL OPENING<br />6”0clock – Rt side of the anal canal<br />3’0clock – left lateral aspect.<br />
  9. 9. 3D<br />
  10. 10. BRIEF ABOUT PERIANAL FISTULA’S<br />ETIOLOGY<br />Crptoglandular hypothesis <br />Crohn disease <br />Tuberculosis <br />Trauma during childbirth,<br />Pelvic infection <br />Pelvic malignancy<br />Radiation therapy<br />PREOPERATIVE EVALUATION OF PERIANAL FISTULAS<br />To define relation of the fistulous tract with sphincter complex ( intersphicteric , trans-sphincteric, suprasphicteric ).<br />Define Secondary tracts/ Ramifications.<br />Define horseshoe tracts.<br />
  11. 11. St James's University Hospital ClassificationMR Imaging Grading of Perianal Fistulas<br />Grade 1: Simple Linear Intersphincteric Fistula.—<br />Grade 2: Intersphincteric Fistula with Abscess or Secondary Track.—<br />No secondary tract / ramifications<br />Secondary tract / ramifications present but pathology is confined by the external sphincteric plane <br />
  12. 12. St James's University Hospital ClassificationMR Imaging Grading of Perianal Fistulas<br />Grade 3: Trans-sphincteric Fistula.<br />Grade 4: Trans-sphincteric Fistula with Abscess or Secondary Track within the IschiorectalFossa.<br />Trans-spincteric fistula with absecss / secondary infection in the ischiorectalfossa<br />Transsphincteric extension with tract extending through the ischirectal / ischio anal region.<br />
  13. 13. St James's University Hospital ClassificationMR Imaging Grading of Perianal Fistulas<br />Grade 5: Supralevator and Translevator Disease.<br />Suprasphincteric ---- high extension through intersphincteric plane<br />Extrasphincteric : Outside the sphincteric mechanism <br />Translevator / supralevator. <br />
  14. 14. CONTRST MR – EXTRA EDGE <br />DELINEATES THE TRACTS , INFECTIVE FOCI IN A BETTER WAY. <br />

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