Utility of fistUlography in diagnosing a post-traUmatic rectal fistUla – a case report

Background. classical fistulography in most coloproctological centers has been replaced by anorectal ultrasound and magnetic resonance fistulography which are considered the „gold standards” in preoperative diagnosis of perianal fistulas. however, in case of a non-cryptogenic fistula, there still is a place for standard fistulography. Aim. to present the role of standard fistulography in the preoperative assessment of a recurrent, post-traumatic fistula-in-ano. Material and Methods. a 47-year-old man was admitted to the proctology department. five years previously he had experienced an impalement injury to the perineum upon a ladder. at that time, the perineal wound was checked and the bleeding controlled. since then he had been operated on four times due to recurrent anal fistulas. anorectal ultrasound, followed by fistulography and computed tomography were performed. Results. anorectal ultrasound demonstrated an extrasphincteric fistula not communicating with the rectum. fistulography revealed the fistula to be running parallel to the rectal wall, and confirmed the lack of an internal opening. additionally, approximately 30 cm from the anal verge, the fistula came to an end with an outline of a non-contrasting foreign body. computer tomography showed this foreign body to be located within the right iliopsoas muscle, with its lower margin against the right iliac artery. laparotomy was performed, and a 10 cm long piece of wood was removed. Conclusions. 1. in the preoperative diagnostics of a perirectal fistula, whose etiology is not cryptogenic, fistulography serves as an accurate yet simple, fast, and minimally-invasive diagnostic method. 2. computer tomography allows for the precise localization of a foreign body with respect to its surrounding structures.