RESUMO
Objective To investigate the differences in magnetic resonance imaging characteristics between perianal?fistulas of Crohn disease (P?FCD) and perianal?fistulas of non?Crohn disease (P?FNCD). Methods A retrospective analysis was made of 109 patients with perianal fistula who were confirmed by clinical examinations and surgery and had complete preoperative pelvic MRI data from sir run run shaw hospital affiliated to Zhejiang University from June 2015 to March 2017. Patients were divided into P?FCD and P?FNCD groups according to whether the patient was clinically diagnosed with Crohn disease (CD). There were 59 cases in group P?FCD and 50 cases in group P?FNCD. All patients underwent pelvic MRI plain scan and enhanced scan. the classifications of perianal fistula (St. James University Hospital classification and improved Parks classification) were evaluated. The number of branches, the number of abscesses, the number of internal opening, the height of the internal opening were measured and recorded. The incidence of proctitis and anal inflammation were recorded. Van Assche score was evaluated. Measured data between patients in the P?FCD and P?FNCD groups were compared using independent sample t test (normal distribution) or non?parametric test (skewed distribution).The quantitative data were compared using cross?sectional Pearson χ2 test. Results There were significant differences in the number of branches, the number of abscesses, the number of internal opening, the height of the internal opening, the positive rate of proctitis, the positive rate of anal canalitis, and the Van Assche score between the P?FCD group and the P?FNCD group (all P<0.05). There was no significant difference in the modified Parks classification between the P?FCD group and the P?FNCD group (P>0.05).There was significant difference in the classification of St. James University Hospital between the P?FCD group and the P?FNCD group (P<0.05). Conclusions P?FCD is mainly composed of high complex anal fistula, which is significantly different from P?FNCD. We used St. James University Hospital classification and Van Assche score to diagnose perianal fistula in combination with clinical examinations, which was helpful for the diagnosis of P?FCD.
RESUMO
Crohn's disease is an inflammatory bowel disease that affects the intestinal bowel in a transmural way presenting with fistulizing phenotypes with abnormal communication between two epithelial surfaces. In perianal Crohn's disease, there are fistulizing tracts between the anal canal and perianal skin that can complicate with abscess formation. Symptoms include pain, perianal discharge and fluctuating lesions, requiring combined clinical and surgical management. The disease is difficult to treat and is associated with significant reduction in quality of life, requiring a multidisciplinary approach for the management of these patients. The following review describes clinical concepts of perianal Crohn's disease, with emphasis on diagnosis and treatment.
La enfermedad de Crohn es una enfermedad inflamatoria del tubo digestivo con compromiso transmural de la pared que puede manifestarse con fenotipos fistulizantes mediante el desarrollo de comunicaciones anormales entre dos superficies epiteliales. En el caso de la enfermedad de Crohn perianal se establecen trayectos fistulosos entre el epitelio del canal anal y la piel alrededor del ano, que pueden complicarse con la formación de abscesos. Clínicamente se presenta con descarga perianal, dolor y masa fluctuante requiriendo un manejo conjunto médico-quirúrgico para el tratamiento de las complicaciones, el control de las fístulas y el compromiso luminal asociado. Es necesario un enfoque multidisciplinario dado que es una enfermedad de difícil manejo que afecta la calidad de vida de los pacientes. En la siguiente revisión se exponen conceptos acerca de la enfermedad de Crohn fistulizante perianal y sus complicaciones, con énfasis en el diagnóstico y tratamiento.
Assuntos
Humanos , Doença de Crohn/complicações , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retal/terapia , Imageamento por Ressonância Magnética , Doenças Inflamatórias Intestinais/complicações , Fístula Retal/classificação , AbscessoRESUMO
The goal of this pictorial review is the evaluation of perianal fistulas by means of magnetic resonance imaging. This technique has been shown to demonstrate accurately the anatomy of the perianal region. Our MRI protocol is simple and easy to standardize. We use the classification of St James University Hospital which employs simple anatomic discriminators identifiable on axial and coronal planes. Several examples are shown with emphasis in the importance of this classification.
El objetivo de esta revisión pictográfica es la evaluación de las fístulas anorrectales mediante resonancia magnética. Esta técnica ha demostrado ser altamente confiable para estudiar la anatomía de la región perianal. Nuestro protocolo de estudio es simple y fácil de estandarizar. Usamos la clasificación del Hospital de la Universidad de Saint James (Inglaterra) que enfatiza la relación de la fístula con el esfínter externo y su importancia en la continencia anal.