Alshoabi Sultan Abdulwadoud, Binnuhaid Abdulkhaleq Ayedh, Hamid Abdullgabbar M, Alhazmi Fahad H, Qurashi Abdulaziz A, Gareeballah Awadia, Gameraddin Moawia, Abdulaal Osamah M, Alsharif Walaa, Elajab Fathelrehman A, Daqqaq Tareef S, Al-Sayaghi Khaled Mohammed
Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia.
Department of Specialized Surgery, Radiology Section, Faculty of Medicine, Hadhramout University, Hadhramaut, Republic of Yemen.
Sci Rep. 2025 Jul 1;15(1):22117. doi: 10.1038/s41598-025-06284-3.
A perianal fistula is an abnormal tract connection between the anal canal and the surrounding skin of the perineum, with underdiagnosis in specific populations. The aim of this study was to diagnose and describe the intersphincteric perianal fistulas (number, site, number of internal and external openings, and length) using transcutaneous ultrasound (TCUS) imaging. This was a retrospective study included patients who underwent TCUS for clinically diagnosed of low-type intersphincteric perianal fistulas during April 2017-December 2022. A total of 581 perianal fistulas from 549 patients were included in this study. The mean age of the patients was 36.14 ± 13.37-year (range from 1 to 80 years). The majority were in the young adult age group, from 21 to 40 years (56.47%), 84% were male and 16% female. The patients predominantly had one fistula (94.35%) with one external opening (EO) (79.10%), and one internal opening (IO) (99.65%). The left quadrants (1-6 O'clock around the anus) were the most common sites of the EO (60.5%). The IO was 11-20 mm above the anal verge in 58.5% of fistulas and ≤ 10 mm in 27.4%. The length of the fistular tract was 21-30 mm in 30.1%, 11-20 mm in 27.4%, and 31-40 mm in 25.0%. The perianal fistulas in the left posterior quadrant had a significantly shorter fistular tract compared to those in the other three quadrants. There was no significant variation in the IO distance from anal verge between fistulas in the different anal quadrants. The solitary tract, IO and EO with the short length, and small distance of IO from the anal verge improve surgical outcomes and decrease complications and recurrence of the perianal fistulas. TCUS, when performed by an experienced operator, can be effectively utilized for the diagnosis and surgical planning of low-type perianal fistulas, with the offer of that it is a non-invasive, well-tolerated, and radiation-free imaging method.
肛周瘘是肛管与会阴周围皮肤之间的异常通道连接，在特定人群中存在诊断不足的情况。本研究的目的是使用经皮超声（TCUS）成像诊断并描述括约肌间型肛周瘘（数量、位置、内口和外口数量以及长度）。这是一项回顾性研究，纳入了在2017年4月至2022年12月期间因临床诊断为低位括约肌间型肛周瘘而接受TCUS检查的患者。本研究共纳入了549例患者的581个肛周瘘。患者的平均年龄为36.14±13.37岁（范围为1至80岁）。大多数患者处于21至40岁的青年成年年龄组（56.47%），84%为男性，16%为女性。患者主要有一个瘘管（94.35%），一个外口（EO）（79.10%），一个内口（IO）（99.65%）。外口最常见于左象限（肛门周围1至6点）（60.5%）。58.5%的瘘管内口位于肛缘上方11至20毫米处，27.4%的瘘管内口≤10毫米。瘘管长度为21至30毫米的占30.1%，11至20毫米的占27.4%，31至40毫米的占25.0%。与其他三个象限相比，左后象限的肛周瘘瘘管明显较短。不同肛管象限的瘘管内口距肛缘的距离无显著差异。单一瘘管、内口和外口、较短的长度以及内口距肛缘的较小距离可改善手术效果，减少肛周瘘的并发症和复发。当由经验丰富的操作人员进行时，TCUS可有效地用于低位肛周瘘的诊断和手术规划，因为它是一种无创、耐受性好且无辐射的成像方法。
