Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis.
OBJECTIVE
The aim of this study was to evaluate the accuracy of tridimensional endoanal ultrasound (3D-EAUS) in the diagnosis of perianal sepsis comparing the results with the surgical findings, considered as reference standard.


METHODS
From January 2009 to January 2013, all the patients referred for the assessment and treatment of perianal sepsis with suspected anorectal origin were enrolled in the study. All patients gave informed written consent. Prior to surgery, all the patients underwent anamnestic evaluation, clinical examination, and unenhanced and H2O2-enhanced 3D-EAUS. Surgery was performed by a colorectal surgeon blinded to the 3D-EAUS results.


RESULTS
A total of 212 patients with suspected perianal suppurations were assessed during the study period. In 12 patients, the H2O2-enhanced 3D-EAUS was not performed, and so, they were excluded from the study. Very good agreement between 3D-EAUS and examination under anesthesia (EUA) in the classification of primary fistula tracts (kappa = 0.93) and in the identification of fistula internal opening (kappa = 0.97) was found. There was a good concordance (kappa = 0.71) between 3D-EAUS and surgery in the detection of fistula secondary extensions. The overall sensitivity and specificity of 3D-EAUS in the diagnosis of perianal sepsis were 98.3 and 91.3% respectively.


CONCLUSIONS
3D-EAUS is a safe and reliable technique in the assessment of perianal sepsis. It may assist the surgeon in delineating the fistula tract anatomy and in determining the origin of sepsis, supporting the preoperative planning of definitive and appropriate surgical therapy.
Emergency Department "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
Antonio
A
Brillantino
Francesca
F
Iacobellis
Giandomenico
G
Di Sarno
Francesco
F
D'Aniello
Domenico
D
Izzo
Fiorella
F
Paladino
Maurizio
M
De Palma
Maurizio
M
Castriconi
Roberto
R
Grassi
Natale
N
Di Martino
Adolfo
A
Renzi
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D001004:Anus Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012003:Rectal Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000601:surgery