PRE-OPERATIVE MAGNETIC RESONANCE FISTULOGRAPHY AND ITS CORRELATION WITH POST OPERATIVE FINDINGS IN CASE OF FISTULA IN- ANO AT A TERTIARY CARE HOSPITAL IN NORTH KERALA

Introduction: Perianal fistula is a common clinical problem with considerable morbidity. Accurate preoperative assessment of the perianal fistulous tract determines the success of the surgery. Magnetic resonance imaging fistulography is a non-invasive, safe, and accurate imaging modality. The success of surgery and the likelihood of recurrence are now determined to a great extent by radiographic imaging (including fistulography, computed tomography, endoanal ultrasound imaging, and magnetic resonance imaging) of the complete fistulous tract, ramifications, and related collections. Difficulties in assessing tracts may lead to unsuccessful \"blind\" attempts at tract delineation during surgery. These attempts may result in the failure of surgery with high recurrence rate. Objectives: Main aim of the study is to classify perianal fistulae according to SJUHS classification, and to correlate MR Fistulography evaluation with per operative finding. Methodology: MR fistulography was done in 40 patients over a period of 12 months (June 2021 and November 2022). The sensitivity of MR fistulography is calculated by taking intra operative findings as the gold standard, to be 92%, with permissible error = 10%, Results: In the present study, during a period of 12 months, 40 patients were evaluated with MR fistulography. It was found to be highly sensitive in identifying the internal opening of fistula and secondary tracts, abscess formation. Most common was grade 1 in 22 patients, the remaining were equally distributed in grades II, III, and IV. Commonest internal opening was at 4- 6 O’ clock position. MRI findings were concordant with surgical findings in 37 patients. Conclusions: When compared to operative observations, MR fistulography has become the imaging technique of choice for preoperative evaluation of perianal fistulas. It offers a highly accurate, quick, non-invasive way to perform fistula assessment prior to surgery and is highly sensitive in the detection of the primary tract, internal opening, secondary tract, abscess, and horseshoe extension.