A patient presenting with first time fistula in ano in a five o'clock position . No internal opening could be detected on clinical examination.
It depends, do you suspect a concomitant IBD? Patient refers of a previous perianal abscess? MRI exam has an high level of sensitivity and is a very little invasive study. Why not to do this?
It is important to know the anatomy of the fistula prior to surgery.we have now several options in the management.Also we can inform the patient about the possible out come.For a recurrent fistula it is all the more important.If the facility is not available it is a different matter.
We only do it when we can not explore the internal orifice or if we have doubt about a possible abscess
Owing to its high soft tissue contrast, MRI was proven to be the imaging tool of choice for preoperative diagnosis and classification of perianal fistulas with perfect spatial localization of the internal opening, side branches and abscess, in this way chances of missing of internal openings is very low, reaching to zero.
A quote from Korman's Colon & Rectal Surgery :
'At the very least, endosonography and MRI may explain why one fails to correct complex or recurrent anal fistulas surgically'
Obviously not in all cases, it is important in recurrent fistula, when high fistula is suspected it is very important to have MRI done.
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