"iatrogenic: post-surgical complication"
"post-ultralow anterior resection"
"post-pelvic radiation therapy"
"Parks classification: trans-, inter-, supra-, or extra-sphincteric"
"an exception to this rule is external openings >3cm from the anal verge, anterior to the transverse anal line, as most originate as a primary or secondary tract from the posterior midline consistent with a prior horseshoe abscess 4"
"grade 1: simple linear intersphincteric"
"grade 2: intersphincteric with abscess or secondary tract"
"grade 3: transsphincteric"
"grade 4: transsphincteric with abscess or secondary tract within the ischiorectal fossa"
"grade 5: supralevator and translevator extension"
"T1: isointense to muscle"
"T2: high signal compared to fat"
"T2-FS: high signal compared to fat"
"T1 C+: rim enhancement"
"Goodsall's rule was historically used to predict the course of the fistula and internal opening. It states that the internal opening of the fistula is dependent on where the fistula is located relative to the 'anal clock' (i.e. with the patient in the lithotomy position, anterior is 12 o'clock and posterior is 6 o'clock) and the transverse anal line (a line drawn from 9 o'clock to 3 o'clock):"
"if the external opening is anterior to the transverse anal line, there will be a (usually simple) direct radial fistulous tract"
"if the external opening is posterior to the transverse anal line, there will be a tortuous (and often more complex) fistulous tract that enters posteriorly in the midline (6 o'clock)"
"These can also be applied in combination. Infusion of hydrogen peroxide into the fistulous tract renders it hyperechoic, thus facilitating its delineation. Doppler interrogation can show hyperaemia in active Crohn's disease."
"T2-FS: high signal compared to fat"
"chronic tracts have low signal on both T1- and T2-WI and will not show contrast enhancement"
"Parks classification: trans-, inter-, supra-, or extra-sphincteric"
Expected headings
"Associations"
"Classifications"
"Surgical classification"
"Radiological classification"
"Fistulography"
"MRI"
"The most commonly accepted pathophysiology is the cryptoglandular hypothesis, which suggests that obstruction of the deep submucosal glands results in infection and abscess formation in the intersphincteric space, which consequently drains inferiorly between the sphincters, opening onto the skin surface or, less commonly, erodes through both the internal and external sphincters into the ischiorectal space, then onto the skin surface 1."
"the accuracy of Goodsall's rule has been debated, with some studies reporting predictive accuracy up to 75% for posterior fistulae; the accuracy for anterior fistulae is considerably lower 13"
"The benefits of ultrasonography over MRI include its ubiquity and lower operating costs 8. There are three ultrasonography methods for the evaluation of perianal fistulae, whether cryptoglandular or Crohn disease-associated 9:"