Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Imaging of Perianal Inflammatory Disorders in Ulcerative Colitis

  • Chapter
  • First Online:
Imaging of Ulcerative Colitis

  • 1280 Accesses

Abstract

Perianal disease (PAD) sometimes complicates true ulcerative colitis (UC) with an incidence approaching 5 %. Although its pathogenesis is unknown and probably multifactorial, reassessment of clinical, endoscopic, histological, and imaging findings is always recommended to exclude a misdiagnosed Crohn’s disease (CD). Moreover, PAD may occur in UC patients who undergo colectomy with ileal pouch-anal anastomosis (IPAA). Pouch fistulas can be classified into pouch CD-related fistulas, arising in a setting of de novo CD of the pouch, or nonpouch CD-related fistulas, usually representing the later presentation of an initial anastomotic leak. PAD may involve the genital region, mostly in female patients with a 4–12 % incidence rate of ileal pouch-vaginal fistulas. Imaging of the perianal compartment is crucial for prompt and accurate diagnostic assessment of PAD in UC patients, especially for potential candidates for surgery, both in the preoperative and postoperative settings. Magnetic resonance imaging (MRI) is considered the gold standard technique in the assessment and follow-up of PAD, whereas computed tomography (CT) plays a major role in emergency conditions. Transanal and transperineal ultrasound represent low cost and accurate imaging modalities currently used in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hamzaoglu I, Hodin RA (2005) Perianal problems in patients with ulcerative colitis. Inflamm Bowel Dis 11:856–859

    Article  PubMed  Google Scholar 

  2. de Dombal FT, Watts JM, Watkinson G et al (1966) Incidence and management of anorectal abscess, fistula, and fissure in patients with ulcerative colitis. Dis Colon Rectum 9:201–216

    Article  PubMed  Google Scholar 

  3. Zabana Y, Van Domselaar M, Garcia-Planella E et al (2011) Perianal disease in patients with ulcerative colitis: a case-control study. J Crohn’s Colitis 5:338–341

    Article  Google Scholar 

  4. Tonolini M, Bareggi E (2011, Jul 21) Unusual perianal inflammatory disease complicating ulcerative colitis. http://www.eurorad.org/case.php?id=9119

  5. Richard CS, Cohen Z, Stern HS et al (1997) Outcome of the pelvic pouch procedure in patients with prior perianal disease. Dis Colon Rectum 40:647–652

    Article  PubMed  CAS  Google Scholar 

  6. Alexander F, Sarigol S, DiFiore J et al (2003) Fate of the pouch in 151 pediatric patients after ileal pouch anastomosis. J Pediatr Surg 38:78–82

    Article  PubMed  Google Scholar 

  7. Fazio VW, Tekkis PP, Remzi F et al (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238:605–617

    PubMed  Google Scholar 

  8. Shen B, Remzi FH, Lavery IC et al (2008) A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 6(2):145–158

    Article  PubMed  Google Scholar 

  9. Shen B (2010) Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 23:259–268

    Article  PubMed  Google Scholar 

  10. Baik SH, Kim WH (2012) A comprehensive review of inflammatory bowel disease focusing on surgical management. J Korean Soc Coloproctol 28(3):121–131

    Article  PubMed  Google Scholar 

  11. Goldstein NS, Sanford WW, Bodzin JH (1997) Crohn’s-like complications in patients with ulcerative colitis after total proctocolectomy and ileal pouch-anal anastomosis. Am J Surg Pathol 21:1343–1353

    Article  PubMed  CAS  Google Scholar 

  12. Viscido A, Habib FI, Kohn A et al (2003) Infliximab in refractory pouchitis complicated by fistulae following ileo-anal pouch for ulcerative colitis. Aliment Pharmacol Ther 17:1263–1271

    Article  PubMed  CAS  Google Scholar 

  13. Beliard A, Prudhomme M (2010) Ileal reservoir with ileo-anal anastomosis: long-term complications. J Visc Surg 147(3):137–144

    Article  Google Scholar 

  14. Van Assche G, Dignass A, Bokemeyer B et al (2013) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohn’s Colitis 7:1–33

    Article  Google Scholar 

  15. Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patients management. Radiographics 20:623–637

    Article  PubMed  CAS  Google Scholar 

  16. Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239:18–33

    Article  PubMed  Google Scholar 

  17. Beets-Tan RG, Beets GL, van der Hoop AG et al (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84

    Article  PubMed  CAS  Google Scholar 

  18. Sahni VA, Ahmad R, Burling D (2008) Which method is best for imaging of perianal fistula? Abdom Imaging 33:26–30

    Article  PubMed  Google Scholar 

  19. Van Assche G, Vanbeckevoort D, Bielen D et al (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98:332–339

    Article  PubMed  Google Scholar 

  20. Bell SJ, Halligan S, Windsor AC et al (2003) Response of fistulating Crohn’s disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther 17:387–393

    Article  PubMed  CAS  Google Scholar 

  21. Spencer JA, Ward J, Beckingham IJ et al (1996) Dynamic contrast-enhanced MR imaging of perianal fistulas. AJR 167:735–741

    Article  PubMed  CAS  Google Scholar 

  22. Villa C, Pompili G, Franceschelli G et al (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn’s disease. Eur J Radiol 81:616–622

    Article  PubMed  Google Scholar 

  23. Tonolini M (2012) Ulcerative colits and ileal pouch surgery. In: Tonolini M, Maconi G (eds) Imaging of perianal inflammatory diseases. Springer, Milan, pp 177–183

    Google Scholar 

  24. Campari A, Tonolini M (2012) MRI study protocol. In: Tonolini M, Maconi G (eds) Imaging of perianal inflammatory diseases. Springer, Milan, pp 127–132

    Google Scholar 

  25. Criado JM, del Salto JG, Rivas P et al (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. RadioGraphics 32:175–194

    Article  Google Scholar 

  26. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63(1):1–12

    Article  PubMed  CAS  Google Scholar 

  27. Maccioni F, bella G, Buonocore V (2012) Perianal Crohn’s disease MRI classification and staging. In: Tonolini M, Maconi G (eds) Imaging of perianal inflammatory diseases. Springer, Milan, pp 143–164

    Google Scholar 

  28. Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. RadioGraphics 20(3):623–637

    Article  PubMed  CAS  Google Scholar 

  29. Norsa AH, Tonolini M (2012) Techniques and role of CT in perianal disease. In: Tonolini M, Maconi G (eds) Imaging of perianal inflammatory diseases. Springer, Milan, pp 213–218

    Google Scholar 

  30. Ardizzone S, Maconi G, Cassinotti A (2007) Imaging of perianal Crohn’s disease. Dig Liver Dis 39:970–978

    Article  PubMed  CAS  Google Scholar 

  31. Maconi G, Furfaro F, Bezzio C (2012) Ulcerative colitis. In: Tonolini M, Maconi G (eds) Imaging of perianal inflammatory diseases. Springer, Milan, pp 95–102

    Google Scholar 

  32. Schwartz DA, Wiersema MJ, Dudiak KM et al (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 121:1064–1072

    Article  PubMed  CAS  Google Scholar 

  33. Wedemeyer J, Kirchhoff T, Sellge G et al (2004) Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn’s disease. World J Gastroenterol 10:2859–2863

    PubMed  Google Scholar 

  34. Maconi G, Ardizzone S, Greco S et al (2007) Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn’s disease. Am J Gastroenterol 102(10):2214–2219

    Article  PubMed  Google Scholar 

  35. Tonolini M, Villa C, Campari A et al (2013) Common and unusual urogenital Crohn’s disease complications: spectrum of cross-sectional imaging findings. Abdom Imaging 38:32–41

    Article  PubMed  Google Scholar 

  36. Dwarkasing S, Hussain SM, Hop WCJ et al (2004) Anovaginal fistulas: evaluation with endoanal MR imaging. Radiology 231:123–128

    Article  PubMed  Google Scholar 

  37. Hosseinzadeh K, Heller MT, Houshmand G (2012) Imaging of the female perineum in adults. Radiographics 32:E129–E168

    Article  PubMed  Google Scholar 

  38. Tonolini M, Campari A, Bianco R (2011) Ileal pouch and related complications: spectrum of imaging findings with emphasis on MRI. Abdom Imaging 36:698–706

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Department, ‘Luigi Sacco’ University Hospital, via G.B. Grassi 74, 20157, Milan, Italy

    Chiara Villa

Authors
  1. Chiara Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Villa .

Editor information

Editors and Affiliations

  1. Radiology Unit, "Luigi Sacco" Hospital, Milan, Italy

    Massimo Tonolini

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Villa, C. (2014). Imaging of Perianal Inflammatory Disorders in Ulcerative Colitis. In: Tonolini, M. (eds) Imaging of Ulcerative Colitis. Springer, Milano. https://doi.org/10.1007/978-88-470-5409-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5409-7_13

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5408-0

  • Online ISBN: 978-88-470-5409-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation