Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano
Appropriate classification of the fistulous tracts in patients with fistula-in-ano may be of value for the planning of proper surgery. Conventional transanal ultrasound has limited value in the visualization of fistulous tracts and their internal openings. Hydrogen peroxide can be used as a contrast...
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| Veröffentlicht in: | Diseases of the colon & rectum 1998-09, Vol.41 (9), p.1147-1152 |
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| creator | Poen, A C Felt-Bersma, R J Eijsbouts, Q A Cuesta, M A Meuwissen, S G |
| description | Appropriate classification of the fistulous tracts in patients with fistula-in-ano may be of value for the planning of proper surgery. Conventional transanal ultrasound has limited value in the visualization of fistulous tracts and their internal openings. Hydrogen peroxide can be used as a contrast medium for ultrasound to improve visualization of fistulas.
This prospective study evaluates hydrogen peroxide-enhanced ultrasound in comparison with physical examination, standard ultrasound, and surgery in the assessment of fistula-in-ano.
Twenty-one consecutive patients (4 women; mean age, 42 years) with fistula-in-ano were evaluated by local physical examination (inspection, probing, and digital examination), conventional ultrasound, and hydrogen peroxide-enhanced ultrasound before surgery. Ultrasound was performed using a B&K Diagnostic Ultrasound System with a 7-MHz rotating endoprobe. Hydrogen peroxide (3%) was infused via a small catheter into the fistula. The results of physical examination, ultrasound, and hydrogen peroxide-enhanced ultrasound were compared with surgical data as the criterion standard. The additive value of standard ultrasound and hydrogen peroxide-enhanced ultrasound compared with physical examination was also determined.
At surgery, 8 intersphincteric and 11 transsphincteric fistulas and 2 sinus tracts (without an internal opening) were found. During physical examination, probing was incomplete in 13 patients, the diagnosis being correct in the other 8 patients (38%) as a low (intersphincteric or transsphincteric) fistula. With conventional ultrasound, the assessment of fistula-in-ano was correct in 13 patients (62%); defects in one or both sphincters could also be found (n = 8). With hydrogen peroxide-enhanced ultrasound, the fistulous tract was classified correctly in 20 patients, the overall concordance with surgery being 95%. The internal opening was found at physical examination in 15 patients (71%), with hydrogen peroxide-enhanced ultrasound in 10 patients (48%), and during surgery in 19 patients (90%). Secondary extensions, confirmed during surgery, were found in five cases. In two patients, a secondary extension with hydrogen peroxide-enhanced ultrasound was not confirmed during surgery. Both patients developed a recurrent fistula.
Hydrogen peroxide-enhanced ultrasound is superior to physical examination and standard ultrasound in delineating the anatomic course of perianal fistulas. It makes accurate preoperative assessment |
| doi_str_mv | 10.1007/BF02239437 |
| format | Article |
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This prospective study evaluates hydrogen peroxide-enhanced ultrasound in comparison with physical examination, standard ultrasound, and surgery in the assessment of fistula-in-ano.
Twenty-one consecutive patients (4 women; mean age, 42 years) with fistula-in-ano were evaluated by local physical examination (inspection, probing, and digital examination), conventional ultrasound, and hydrogen peroxide-enhanced ultrasound before surgery. Ultrasound was performed using a B&K Diagnostic Ultrasound System with a 7-MHz rotating endoprobe. Hydrogen peroxide (3%) was infused via a small catheter into the fistula. The results of physical examination, ultrasound, and hydrogen peroxide-enhanced ultrasound were compared with surgical data as the criterion standard. The additive value of standard ultrasound and hydrogen peroxide-enhanced ultrasound compared with physical examination was also determined.
At surgery, 8 intersphincteric and 11 transsphincteric fistulas and 2 sinus tracts (without an internal opening) were found. During physical examination, probing was incomplete in 13 patients, the diagnosis being correct in the other 8 patients (38%) as a low (intersphincteric or transsphincteric) fistula. With conventional ultrasound, the assessment of fistula-in-ano was correct in 13 patients (62%); defects in one or both sphincters could also be found (n = 8). With hydrogen peroxide-enhanced ultrasound, the fistulous tract was classified correctly in 20 patients, the overall concordance with surgery being 95%. The internal opening was found at physical examination in 15 patients (71%), with hydrogen peroxide-enhanced ultrasound in 10 patients (48%), and during surgery in 19 patients (90%). Secondary extensions, confirmed during surgery, were found in five cases. In two patients, a secondary extension with hydrogen peroxide-enhanced ultrasound was not confirmed during surgery. Both patients developed a recurrent fistula.
Hydrogen peroxide-enhanced ultrasound is superior to physical examination and standard ultrasound in delineating the anatomic course of perianal fistulas. It makes accurate preoperative assessment of the fistula possible and may be of value for the surgeon in planning therapeutic strategy.</description><identifier>ISSN: 0012-3706</identifier><identifier>DOI: 10.1007/BF02239437</identifier><identifier>PMID: 9749499</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Contrast Media ; Endosonography ; Female ; Humans ; Hydrogen Peroxide ; Image Enhancement ; Male ; Middle Aged ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - surgery ; Rectal Fistula - diagnostic imaging ; Rectal Fistula - surgery ; Recurrence ; Reoperation</subject><ispartof>Diseases of the colon & rectum, 1998-09, Vol.41 (9), p.1147-1152</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9749499$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poen, A C</creatorcontrib><creatorcontrib>Felt-Bersma, R J</creatorcontrib><creatorcontrib>Eijsbouts, Q A</creatorcontrib><creatorcontrib>Cuesta, M A</creatorcontrib><creatorcontrib>Meuwissen, S G</creatorcontrib><title>Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>Appropriate classification of the fistulous tracts in patients with fistula-in-ano may be of value for the planning of proper surgery. Conventional transanal ultrasound has limited value in the visualization of fistulous tracts and their internal openings. Hydrogen peroxide can be used as a contrast medium for ultrasound to improve visualization of fistulas.
This prospective study evaluates hydrogen peroxide-enhanced ultrasound in comparison with physical examination, standard ultrasound, and surgery in the assessment of fistula-in-ano.
Twenty-one consecutive patients (4 women; mean age, 42 years) with fistula-in-ano were evaluated by local physical examination (inspection, probing, and digital examination), conventional ultrasound, and hydrogen peroxide-enhanced ultrasound before surgery. Ultrasound was performed using a B&K Diagnostic Ultrasound System with a 7-MHz rotating endoprobe. Hydrogen peroxide (3%) was infused via a small catheter into the fistula. The results of physical examination, ultrasound, and hydrogen peroxide-enhanced ultrasound were compared with surgical data as the criterion standard. The additive value of standard ultrasound and hydrogen peroxide-enhanced ultrasound compared with physical examination was also determined.
At surgery, 8 intersphincteric and 11 transsphincteric fistulas and 2 sinus tracts (without an internal opening) were found. During physical examination, probing was incomplete in 13 patients, the diagnosis being correct in the other 8 patients (38%) as a low (intersphincteric or transsphincteric) fistula. With conventional ultrasound, the assessment of fistula-in-ano was correct in 13 patients (62%); defects in one or both sphincters could also be found (n = 8). With hydrogen peroxide-enhanced ultrasound, the fistulous tract was classified correctly in 20 patients, the overall concordance with surgery being 95%. The internal opening was found at physical examination in 15 patients (71%), with hydrogen peroxide-enhanced ultrasound in 10 patients (48%), and during surgery in 19 patients (90%). Secondary extensions, confirmed during surgery, were found in five cases. In two patients, a secondary extension with hydrogen peroxide-enhanced ultrasound was not confirmed during surgery. Both patients developed a recurrent fistula.
Hydrogen peroxide-enhanced ultrasound is superior to physical examination and standard ultrasound in delineating the anatomic course of perianal fistulas. It makes accurate preoperative assessment of the fistula possible and may be of value for the surgeon in planning therapeutic strategy.</description><subject>Adult</subject><subject>Contrast Media</subject><subject>Endosonography</subject><subject>Female</subject><subject>Humans</subject><subject>Hydrogen Peroxide</subject><subject>Image Enhancement</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - surgery</subject><subject>Rectal Fistula - diagnostic imaging</subject><subject>Rectal Fistula - surgery</subject><subject>Recurrence</subject><subject>Reoperation</subject><issn>0012-3706</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNotkDFPwzAUhD2ASiks7Eie2AwvtlPHI1SUIlViAOboJX6mQYkd4kSi_55IdLo76fTpdIzdZHCfAZiHpy1IqaxW5owtATIplIH1BbtM6XuOIMEs2MIabbW1S_a-O7ohflHgPQ3xt3EkKBww1OT4OGBIGLDlUzv7FKfgeBP4eCCOKVFKHYWRR899k8apRdEEgSFesXOPbaLrk67Y5_b5Y7MT-7eX183jXvSZKkYhoUKoXUGyKFSxdvMiY7S3la5zrVXljc085IWqwaMkneeu8jWS85qkylCt2N0_tx_iz0RpLLsm1dS2GChOqTTKSoAZvmK3p-JUdeTKfmg6HI7l6QX1B6YQXRA</recordid><startdate>199809</startdate><enddate>199809</enddate><creator>Poen, A C</creator><creator>Felt-Bersma, R J</creator><creator>Eijsbouts, Q A</creator><creator>Cuesta, M A</creator><creator>Meuwissen, S G</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>199809</creationdate><title>Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano</title><author>Poen, A C ; Felt-Bersma, R J ; Eijsbouts, Q A ; Cuesta, M A ; Meuwissen, S G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p138t-20ba0cd8e288386d494774f9b4c5443bf791f0583c0fa2e455dbfcaedf4e231a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Contrast Media</topic><topic>Endosonography</topic><topic>Female</topic><topic>Humans</topic><topic>Hydrogen Peroxide</topic><topic>Image Enhancement</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - surgery</topic><topic>Rectal Fistula - diagnostic imaging</topic><topic>Rectal Fistula - surgery</topic><topic>Recurrence</topic><topic>Reoperation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poen, A C</creatorcontrib><creatorcontrib>Felt-Bersma, R J</creatorcontrib><creatorcontrib>Eijsbouts, Q A</creatorcontrib><creatorcontrib>Cuesta, M A</creatorcontrib><creatorcontrib>Meuwissen, S G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poen, A C</au><au>Felt-Bersma, R J</au><au>Eijsbouts, Q A</au><au>Cuesta, M A</au><au>Meuwissen, S G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>1998-09</date><risdate>1998</risdate><volume>41</volume><issue>9</issue><spage>1147</spage><epage>1152</epage><pages>1147-1152</pages><issn>0012-3706</issn><abstract>Appropriate classification of the fistulous tracts in patients with fistula-in-ano may be of value for the planning of proper surgery. Conventional transanal ultrasound has limited value in the visualization of fistulous tracts and their internal openings. Hydrogen peroxide can be used as a contrast medium for ultrasound to improve visualization of fistulas.
This prospective study evaluates hydrogen peroxide-enhanced ultrasound in comparison with physical examination, standard ultrasound, and surgery in the assessment of fistula-in-ano.
Twenty-one consecutive patients (4 women; mean age, 42 years) with fistula-in-ano were evaluated by local physical examination (inspection, probing, and digital examination), conventional ultrasound, and hydrogen peroxide-enhanced ultrasound before surgery. Ultrasound was performed using a B&K Diagnostic Ultrasound System with a 7-MHz rotating endoprobe. Hydrogen peroxide (3%) was infused via a small catheter into the fistula. The results of physical examination, ultrasound, and hydrogen peroxide-enhanced ultrasound were compared with surgical data as the criterion standard. The additive value of standard ultrasound and hydrogen peroxide-enhanced ultrasound compared with physical examination was also determined.
At surgery, 8 intersphincteric and 11 transsphincteric fistulas and 2 sinus tracts (without an internal opening) were found. During physical examination, probing was incomplete in 13 patients, the diagnosis being correct in the other 8 patients (38%) as a low (intersphincteric or transsphincteric) fistula. With conventional ultrasound, the assessment of fistula-in-ano was correct in 13 patients (62%); defects in one or both sphincters could also be found (n = 8). With hydrogen peroxide-enhanced ultrasound, the fistulous tract was classified correctly in 20 patients, the overall concordance with surgery being 95%. The internal opening was found at physical examination in 15 patients (71%), with hydrogen peroxide-enhanced ultrasound in 10 patients (48%), and during surgery in 19 patients (90%). Secondary extensions, confirmed during surgery, were found in five cases. In two patients, a secondary extension with hydrogen peroxide-enhanced ultrasound was not confirmed during surgery. Both patients developed a recurrent fistula.
Hydrogen peroxide-enhanced ultrasound is superior to physical examination and standard ultrasound in delineating the anatomic course of perianal fistulas. It makes accurate preoperative assessment of the fistula possible and may be of value for the surgeon in planning therapeutic strategy.</abstract><cop>United States</cop><pmid>9749499</pmid><doi>10.1007/BF02239437</doi><tpages>6</tpages></addata></record> |
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| ispartof | Diseases of the colon & rectum, 1998-09, Vol.41 (9), p.1147-1152 |
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| source | MEDLINE; Journals@Ovid Complete; Alma/SFX Local Collection |
| subjects | Adult Contrast Media Endosonography Female Humans Hydrogen Peroxide Image Enhancement Male Middle Aged Postoperative Complications - diagnostic imaging Postoperative Complications - surgery Rectal Fistula - diagnostic imaging Rectal Fistula - surgery Recurrence Reoperation |
| title | Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano |
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