Endoanal ultrasound versus Magnetic resonance Imaging for perianal sepsis
- Report By: Aamir Z Khan - Specialist Registrar General Surgery
- Search checked by Xavier Escofet - Specialist Registrar General Surgery
- Institution: Dept of Surgery, East Surrey Hospital
- Current web editor: Minnie Alexander - Senior Information Officer
- Date Submitted: 6th December 2001
- Last Modified: 14th December 2001
-
Status:
Blue (submitted but not checked)
Three Part Question
[For Recurrent Perianal sepsis] [is magentic resonance imaging better than endoanal ultrasound] for [evaluating fistulous tracks]Clinical Scenario
A 20 year old female presents to casualty with complaints of recurrent pain and swelling in the perianal region. She has had similiar symptoms in the past and a perianal abscess was drained in the past but never really healed. On examination she has a small abscess with a fistulous track palpable. A diagnosis of recurrent perianal abscess is with an underlying fistula in ano. What is the evidence for the best available investigation to map the fistulous tracks.Search Strategy
Medline 1966-12/01 using the OVID interface({perianal sepis.mp. AND magnestic resonance imaging.mp.} OR {perianal sepsis.mp. AND endosonography}).
Search Outcome
8 articles. Only One non randomized prospective study comparing MRI and Endoanal sonography for evaluating perianal sepsis. Several reports about the role of MRI in evaluating perianal sepsis. A couple of reports quoting early experiences with perianal sepsis.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Maier et al, 2001, Austria | Patients presenting with perianal fistulae and sepsis investigated either with anal endosongraphy or magnetic resonance imaging. Findings compared at surgery | Prospective, non randomized | Diagnostic yeild of MRI and Anal Endosonography in the assessment of perianal abscesses and fistualae | MRI appears to be more specific and sensitive in the assessment of fistulous tracks in perianal sepsis | 1.Non randomized 2.Level of expertise of person performing anal endosongraphy not mentioned, this could have biased the results in favour of MRI |
Comment(s)
There are no randomized trials comparing MRI and anal endosonography.Clinical Bottom Line
The current evidence supports MRI as the most accurate investigation for evaluating fistulous tracks in perianal sepsis.References
- Maier AG, Funovics MA and Kreuzer SH et al Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging Journal of Magnetic Resonance Imaging 2001 Sep;14(3):254-260.