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  • Title: [Ultrasonography in the diagnosis of enterocutaneous fistula in Crohn's disease].
    Author: Cerro P, Scribano ML, Falasco G, Zannoni F, Spina C.
    Journal: Radiol Med; 1998 Sep; 96(3):214-7. PubMed ID: 9850714.
    Abstract:
    INTRODUCTION: Perforation seems to be a specific pathologic aspect in some types of Crohn's disease. Fistulae are caused by a transmural extension of a fissure and/or an ulcer; they are often multiple and can be internal or external. External fistulae usually occur after surgery and along the scar incision. They are frequently complicated by associated intra-abdominal abscesses. We investigated the accuracy of fistulography by ultrasonography compared to fistulography by X-rays in the diagnosis of enterocutaneous fistulae. MATERIAL AND METHODS: Eight patients resected for Crohn's ileitis and with enterocutaneous fistulae were examined by fistulography with ultrasonography and then by fistulography with X-rays. Disease recurrence was established with ultrasonography on ileum anastomosis in all patients. A7.5 MHz linear transducer was connected to a videotape. Physiologic solution was injected into the cutaneous orifice using a thin rigid catheter to evaluate the communication with the intestinal tract by fistulography. At the same time all patients underwent fistulography with contrast agent injection through a radiopaque catheter. RESULTS: On the same day two radiologists performed the ultrasonographic and the radiologic examinations and had 100% agreement between the two methods. In five of eight patients (62%) there was no intestinal communication. Ultrasonography showed hypoechoic lines turning deeply from the cutaneous surface with no communication with the intestinal tract. Radiology confirmed the ultrasonography diagnosis. In two of five patients the fistulae ended in small abscesses. The patients had been treated with immunosuppressive or parenteral therapy; four of them improved and one underwent abscess drainage. In three of eight patients cutaneous fistulae communicated with the intestinal anastomosis. In one patient there was an abscess with multiple fistulae, one of which communicated with the third duodenal segment. DISCUSSION: The origin, anatomic course and sites of communication of fistulae should be evaluated with conventional barium studies first. These studies may be limited by the fact that the origin of the fistulae could be edematous and prevent contrast opacification, in which cases conventional fistulography or ultrasonographic fistulography should be performed. CONCLUSIONS: Our experience suggests that ultrasonography is a reliable method for detecting intestinal alterations and especially the complications typical of Crohn's disease such as enterocutaneous fistulae.
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