Miejsce współczesnej endosonografii w diagnostyce obrazowej powikłań po operacjach koloproktologicznych

*Iwona Sudoł-Szopińska^{1, 2}, Małgorzata Kołodziejczak², Mariusz Furmanek³, Marek Szczepkowski⁴

Summary
This article presents the potential of modern imaging techniques (magnetic resonance, computer tomography and endosonography) in diagnosing complications of coloproctological operations. There was a special focus on endosonography, used routinely in our own proctological practice, and its value in diagnosing recurrent fistulas, poorly-draining anal abscesses, and damage to anal sphincters. In the case of recurrent fistulas, the endosonographic image is usually unambiguous and can well differentiate between post-operative scarring and recurrence of a fistula. If there would be any doubts, endosonography with contrast may be used. Further development brought 3D ultrasonography with various postprocessing techniques of the 3D data. Initial reports show that compared to traditional endosonography, the Volume Render Mode technique in B-mode grey scale is more sensitive in locating the internal opening of fistulas, differentiating scars from fistula recurrences, in diagnosing residual abscesses and injuries of anal sphincters. An examination using a 3D rectal probe placed in the immediate vicinity of the anus enables diagnosis of anal canal stenosis, even when its degree prevents a proper per rectum exam and full endosonographic evaluation (which would accurately assess the length and level of the stenosis and any concomitant changes in anal sphincters). Perineal ultrasonography is also important in the diagnosis of superficially located fistulas and anal abscesses, including recurrent ones, or fistulas coexisting with advanced changes like hidradenitis suppurativa, as well as in differentiating apocrine gland inflammation from anal fistulas, when the cutaneous presentation of hidradenitis suppurativa is not characteristic.

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