ABSTRACT
Purpose@#According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula. @*Methods@#All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital. @*Results@#A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence. @*Conclusion@#Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.
ABSTRACT
Laparoscopic cholecystectomy has recently been accepted as a procedure of choice for treating cholelithiasis. Its complication rates were known to be comparable to classical cholecystectomy. Hemobilia is very rare after cholecystectomy but is one of the lethal complications that may occur weeks to months after the operation. Therefore, it is important to keep in mind that hemobilia due to communications between cystic duct and cystic artery or right hepatic artery pseudoaneurysms, can occur in the patients who have history of laparoscopic cholecystectomy when they have upper gastro-intestinal bleeding. Selective hepatic arteriography can be an important diagnostic and therapeutic modality having high success rate (81-96%). We report a case of hemobilia caused by cystic artery pseudoaneurysm following laparoscopic cholecystectomy which was undergone 1 month before admission, and will discuss the mechanism and the treatment of the pseudoaneurysm associated with hemobilia.