Perianal abscess refers to a formed infective-inflammatory collection within the perianal region. It forms part of the broader group of anorectal abscesses. No seguimento, a incidência de formação de fístula nos pacientes com abscesso perianal após a incisão e drenagem foi de 31/68 (45,58%). Perianal and perirectal abscesses are common anorectal problems. The infection originates most often from an obstructed anal crypt gland.

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If there is an extrasphincteric fistula, the lower part is opened.

Perianal suppuration: results of treatment.

You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. These are more often due to Crohns disease or anorectal procedures such as haemorrhoidectomy or sphincterotomy. The treatment given depends on the anatomy of the fistula, if it is a simple fistula with a low mucosal defect is can be probed in the OR to identify the mucosal defect at the linea dentata, then the tract can be opened.

Two tracts in the left buttock form a single tract no.

Associations Recognised associations include: The total length of the surgical anal canal is about cm. This is only possible if the abscesao sphincter is not involved. Infection and anal gland drainage obstruction from the perianal fistula may lead to an acute perianal abscess.

In the tract there is a linear structure with a low signal intensity.

Case 7 Case abbscesso. Extrasphincteric fistula On the left coronal T2W-images of a small abscess in the left ischioanal fossa, the fistula runs through abscessp levator ani. These three layers are continuous cranially with the puborectal muscle and levator ani figure. On the left axial T2W images with and without fat saturation.


Any localizer that properly displays the anal canal can be used. Use the arrows to scroll through the images. Log in Sign up. On the left an example of a complex fistula.

The Radiology Assistant : Rectum – Perianal Fistulas

This fistula breaks through the external sphincter no. There is a small abscess just above the nates. Case 2 Case 2. On the left an example of a suprasphincteric fistula. Reporting When you describe a fistula, it is important to mention the following characteristics: Primary Obstruction of anal gland which leads to stasis and infection with absces and fistula formation most common cause.

Distance of the mucosal defect to the perianal skin on coronal images. While some abscesses may resolve spontaneously via internal drainage into the anal canal, others may require surgical incision and drainage. The most widely used classification is the Parks Classification which distinguishes four kinds of fistula: The anal sphincter is comprised of three layers: In the intersphincteric space it divides again into two tracts no.

The extrasphincteric fistula is uncommon and only seen in patients who had multiple operations. Loading Stack – 0 images remaining. The anatomical anal canal extends from the perineal skin to the linea dentata. The causes of perianal fistulas:. There is no relation with the sphincter complex. There is no connection with the external sphincter. Support Radiopaedia and see fewer ads.

Rectum – Perianal Fistulas

absceso Sinus pilonidalis On the left an example of a sinus pilonidalis. One ends blindly in the intersphincteric space no. This patient was already known to have an intersfincteric fistula, the mucosal defect is at 1 o’clock. Crohn’s disease On the left a patient with a perianal fistula who has Crohn’s disease.


Complex fistula On the left an example of a complex fistula. It forms part of the broader group of anorectal abscesses.

A perianal fistula is an abnormal connection between the epithilialised surface of the anal canal and the skin. The anorectal ring lies approximately ,5 cm above the abscessso dentata. Case 3 Case 3. On the coronal images the thickening of the bowel wall is demonstrated.

The mucosal defect, which is by definition in the rectum, is then surgically closed.

The puborectal muscle is contracted at rest and accounts for the 80? Seton fistulotomy is a technique where a rubber ligature or vessel loop is pulled through the fistula, it then is tightened every 2 weeks or so in order to obtain pressure necrosis so that the Seton is slowly pulled through the muscle. Pathology Infection and anal gland drainage obstruction from the perianal fistula may lead to an acute perianal abscess.

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Axial fatsat images depict the transmural inflammation with infiltration of the mesenteric fat. It is therefore above the sphincter complex and extrasphincteric. The right sided tract runs over the puborectal muscle asterisk and the mucosal opening lies at the level of the linea dentata black arrow.

Position of the mucosal opening on axial images using the anal clock.