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Enteric Fistulas and Sinus Tracts
Michael P. Federle, MD, FACR; Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Enteric fistula: Abnormal connection between bowel and another epithelial-lined surface (e.g., bladder, vagina, skin)
          • Enteric sinus tract: Blind-ending tract originating from bowel
          • Perianal fistula: Abnormal communication between anal canal and surrounding soft tissues or skin surface

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • MR Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • Ultrasonographic Findings

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Amiot A et al: Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID. Am J Gastroenterol. 109(9):1443-9, 2014
                                  2. Hall JF et al: Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 57(11):1304-8, 2014
                                  3. Liang C et al: Imaging of anal fistulas: comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol. 15(6):712-23, 2014
                                  4. de Miguel Criado J et al: MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics. 32(1):175-94, 2012
                                  5. O'Malley RB et al: Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI--what the radiologist needs to know. AJR Am J Roentgenol. 199(1):W43-53, 2012
                                  6. Scozzari G et al: Enterovesical fistulas: diagnosis and management. Tech Coloproctol. 14(4):293-300, 2010
                                  7. Horsthuis K et al: Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology. 251(2):380-7, 2009
                                  8. Dave-Verma H et al: Computed tomographic enterography and enteroclysis: pearls and pitfalls. Curr Probl Diagn Radiol. 37(6):279-87, 2008
                                  9. Dionigi G et al: Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg. 6(1):51-6, 2008
                                  10. Kamm MA et al: Perianal fistulizing Crohn's disease: a call to action. Clin Gastroenterol Hepatol. 6(1):7-10, 2008
                                  11. Malagò R et al: Assessment of Crohn's disease activity in the small bowel with MR-enteroclysis: clinico-radiological correlations. Abdom Imaging. 33(6):669-75, 2008
                                  12. Teke Z et al: Crohn's disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis. World J Gastroenterol. 14(1):146-51, 2008
                                  13. Ardizzone S et al: Imaging of perianal Crohn's disease. Dig Liver Dis. 39(10):970-8, 2007
                                  14. Maconi G et al: Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn's disease. Am J Gastroenterol. 102(10):2214-9, 2007
                                  15. Schmidt S et al: Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol. 17(11):2957-63, 2007
                                  16. Szurowska E et al: Perianal fistulas in Crohn's disease: MRI diagnosis and surgical planning : MRI in fistulazing perianal Crohn's disease. Abdom Imaging. Epub ahead of print, 2007
                                  17. Regan JP et al: Laparoscopic treatment of enteric fistulas. Surg Endosc. 18(2):252-4, 2004
                                  18. Kawamura YJ et al: Appendico-ileo-vesical fistula. J Gastroenterol. 33(6):868-71, 1998
                                  19. Beckingham IJ et al: Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano. Br J Surg. 83(10):1396-8, 1996
                                  20. Tsiotos GG et al: Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg. 130(1):48-52, 1995
                                  21. Michelassi F et al: Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease. Ann Surg. 218(5):660-6, 1993
                                  22. Pontari MA et al: Diagnosis and treatment of enterovesical fistulae. Am Surg. 58(4):258-63, 1992
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Enteric fistula: Abnormal connection between bowel and another epithelial-lined surface (e.g., bladder, vagina, skin)
                                          • Enteric sinus tract: Blind-ending tract originating from bowel
                                          • Perianal fistula: Abnormal communication between anal canal and surrounding soft tissues or skin surface

                                        IMAGING

                                        • General Features

                                          • Imaging Recommendations

                                            • Radiographic Findings

                                              • MR Findings

                                                • Fluoroscopic Findings

                                                  • CT Findings

                                                    • Ultrasonographic Findings

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Amiot A et al: Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID. Am J Gastroenterol. 109(9):1443-9, 2014
                                                                  2. Hall JF et al: Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 57(11):1304-8, 2014
                                                                  3. Liang C et al: Imaging of anal fistulas: comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol. 15(6):712-23, 2014
                                                                  4. de Miguel Criado J et al: MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics. 32(1):175-94, 2012
                                                                  5. O'Malley RB et al: Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI--what the radiologist needs to know. AJR Am J Roentgenol. 199(1):W43-53, 2012
                                                                  6. Scozzari G et al: Enterovesical fistulas: diagnosis and management. Tech Coloproctol. 14(4):293-300, 2010
                                                                  7. Horsthuis K et al: Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology. 251(2):380-7, 2009
                                                                  8. Dave-Verma H et al: Computed tomographic enterography and enteroclysis: pearls and pitfalls. Curr Probl Diagn Radiol. 37(6):279-87, 2008
                                                                  9. Dionigi G et al: Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg. 6(1):51-6, 2008
                                                                  10. Kamm MA et al: Perianal fistulizing Crohn's disease: a call to action. Clin Gastroenterol Hepatol. 6(1):7-10, 2008
                                                                  11. Malagò R et al: Assessment of Crohn's disease activity in the small bowel with MR-enteroclysis: clinico-radiological correlations. Abdom Imaging. 33(6):669-75, 2008
                                                                  12. Teke Z et al: Crohn's disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis. World J Gastroenterol. 14(1):146-51, 2008
                                                                  13. Ardizzone S et al: Imaging of perianal Crohn's disease. Dig Liver Dis. 39(10):970-8, 2007
                                                                  14. Maconi G et al: Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn's disease. Am J Gastroenterol. 102(10):2214-9, 2007
                                                                  15. Schmidt S et al: Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol. 17(11):2957-63, 2007
                                                                  16. Szurowska E et al: Perianal fistulas in Crohn's disease: MRI diagnosis and surgical planning : MRI in fistulazing perianal Crohn's disease. Abdom Imaging. Epub ahead of print, 2007
                                                                  17. Regan JP et al: Laparoscopic treatment of enteric fistulas. Surg Endosc. 18(2):252-4, 2004
                                                                  18. Kawamura YJ et al: Appendico-ileo-vesical fistula. J Gastroenterol. 33(6):868-71, 1998
                                                                  19. Beckingham IJ et al: Prospective evaluation of dynamic contrast enhanced magnetic resonance imaging in the evaluation of fistula in ano. Br J Surg. 83(10):1396-8, 1996
                                                                  20. Tsiotos GG et al: Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg. 130(1):48-52, 1995
                                                                  21. Michelassi F et al: Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease. Ann Surg. 218(5):660-6, 1993
                                                                  22. Pontari MA et al: Diagnosis and treatment of enterovesical fistulae. Am Surg. 58(4):258-63, 1992