Abstract
Background: Perianal fistula is a commonly encountered condition in routine surgical
practice. Accurate presurgical mapping of these tracts is vital to prevent recurrence.
We have assessed the effectiveness of percutaneous instillation of aqueous jelly prior
to magnetic resonance (MR) fistulography. Aims and Objectives: To study the role of percutaneous instillation of aqueous jelly in fistulous tracts
prior to MR fistulography. Materials and Methods: All patients with active discharge, referred for MR fistulography between January
2014 and April 2016, were included in this study. Approximately 3–5 ml of sterile
aqueous jelly was percutaneously instilled into the external openings prior to MR
fistulography. Post MR fistulography, patients were monitored till surgery for pain,
fever, or bleeding.The type of fistulae, location of internal openings, lateral ramifications,
and presence of abscess were compared with per operative findings for diagnostic accuracy.
Results: Sixty-four patients enrolled in our study had undergone preoperative MR fistulography
with aqueous jelly instillation. MR fistulography revealed a total of 77 tracts and
showed a sensitivity and specificity of 100% in delineation of type of tract. Forty-nine
internal openings were identified with 94.2% sensitivity, 100% specificity, and 95.3%
accuracy. 90.5% sensitivity, 100% specificity, and accuracy of 97% were observed in
delineation of lateral ramifications. None of the patients reported pain, fever, or
bleeding post procedure till surgery. Conclusion: Percutaneous instillation of aqueous jelly prior to MR fistulography is a safe, cost
effective, and accurate technique to provide a comprehensive delineation of the complex
anatomy of perianal fistulae.
Keywords
Aqueous jelly - magnetic resonance imaging - perianal fistula
