ROLE OF MRI IN EVALUATION OF GRADE IV PERIANAL FISTULA (ACCORDING TO SAINT JAMES'S UNIVERSITY HOSPITAL CLASSIFICATION)

Abstract

Introduction- Fistula-in-ano can be dened as a hollow tract or cavity which is lined by granulation tissue. It is crucial to properly assess these stula-in-ano because surgical intervention must be aimed at not only eradication of stulous tract thereby eradication of source of infection but also at the maintenance of continence which depends on intergrity of anal-sphincter complex. MR stulography has the distinct advantage of not only depicting the stulous tract but also in demonstrating the extent of transmural inammatory process secondary tracts/ramications and abscesses. The aim of the study is to evaluate role of MRI in appropriate diagnosis of Grade IV perianal stulae – Complicated transsphincteric stulae (Saint James's University Hospital Classication) with its post operative correlation. Around 19 patients who were Methodologydiagnosed with grade IV perianal stula (according to Saint James classication) on MR stulogram in the Department of Radiology were included in the study and followed up with their post operative data. A male preponderance Results And Discussion - reported in our study, correlating well with studies by others like Kakani SS et al., Daabis N et al. and Abbas et al. Purulent perianal discharge was common presenting complaints. Most common location for internal opening was posterior position which was also seen in a study by Choudhary J, Kaushal L, Rajput P. Out of the total 19 patients, extrasphincteric abscess/collection was more commonly found in the patients. Majority of the patients had secondary tracts and ramications. In this study accuracy for correct localization of internal opening was (93.33%), identication of ramications/secondary tracts was (92.85 %) and abscesses/collection was (90 %) as compared to operative ndings which correlated well with studies by Singh K et al., Daabis et al. and Madireddy et all MRI is a useful modality for diagnosis and successful mana . Conclusion- gement of grade IV perianal stula. MRI helps in detailed assessment of the number & extent of the stulous tracts and their relationship to anal sphincter complex, including ramications, thereby reducing the recurrence & complications and improving the prognosis.