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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
Fluoroscopy
Fistulogram: Best modality for enterocutaneous fistulas
Small bowel follow-through : Complementary to CT or MR enterography for Crohn's disease
Contrast enema : Often definitive for colonic fistulas (to bladder, vagina, etc.)
CT: Primary or complementary role
Definitive or suggestive signs are present with most enteric & colonic fistulas
e.g., fistulous tract filled with ectopic gas or contrast medium; tethered bowel adherent to abdominal wall, other bowel or viscera
MR is best modality for perianal fistulas
Perianal fistula in active setting usually T2 hyperintense, T1 hypointense and enhancing on T1 C+ MR
Old healed fibrotic fistulas usually hypointense on T1/T2WI and non-enhancing
Parks classification of perianal fistulas
Intersphincteric fistula : Fistula traverses internal anal sphincter and extends downwards to skin surface
Transsphincteric fistula : Fistula traverses both internal and external anal sphincters
Extrasphincteric fistula : Fistula extends from supralevator space into ischioanal fossa without involving sphincter complex
Suprasphincteric fistula : Fistula crosses internal sphincter, rises into supralevator space, and then crosses into ischioanal fossa
Symptoms dependent on type of fistula
Perianal fistulas most commonly present with purulent discharge or local pain and inflammation
Enterocutaneous fistulas often result in infected wound with purulent drainage
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
Best diagnostic clue
Presence of discrete enhancing tract connecting bowel and another epithelial-lined surface
Presence of unexpected gas, debris, or enteric contrast medium within bladder, vagina, etc.
Morphology
Fistula tracts are usually linear, sometimes multiple
Walls of tract are often hyperemic on CECT
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