Role of ultrasonography in evaluation of perianal fistula-A study of 200 cases.

OBJECTIVE: The purpose of this study was to evaluate the role of transrectal, transvaginal, or transperineal ultrasound (US) in evaluation of perianal fistula and to assess the possibility of its role as a first-line investigation for diagnosis and for follow-up as well as a possible substitute for magnetic resonance imaging (MRI). METHODS: This is a retrospective observational study of 200 patients. All the patients complaining of discharging wound, acute or chronic pain in the perianal region and patients suspected clinically having perianal sinus/fistula, referred for ultrasound evaluation were included in the study. Male patients were scanned by transrectal and transperineal ultrasound, and females by transrectal, transvaginal and transperineal approach. All the patients were followed up with referring surgeon till surgical cure, discharge, and follow-up. Out of total 200 patients, 47 were female and 153 were male patients. Patients were in age range from 16 to 74 years. The path, direction, extent, diameter and internal branching and openings of tracts were recorded. Presence, location and extent of any collection/abscess was also noted. RESULTS: Fistulae and sinus tracts are seen as hypo to anechoic tracts ranging from 2 to 10 mm in diameter. Air and mixed echogenic moving collection were noted in active tracts. Fibrous tracts were seen as well defined, echogenic structures. Depending on the chronicity and localization, walls of abscesses appeared ill defined or well defined. Findings of transrectal, transvaginal, and transperineal USG were confirmed with intraoperative findings in 200 cases. Out of which 148 patients were followed up clinically till tracts were closed. In 54 patients, there was recurrence that were operated again and followed up with ultrasound. In total 33 had internal collection along the tracts and in the perianal region. CONCLUSION: Transrectal, transvaginal, and perineal ultrasound together have the potential to reach the sensitivity of MRI. Ultrasound has its greatest advantage in being cheap, easily reproducible and an excellent modality for follow-up.

Periurethral Abscess in Corpus Spongiosum Diagnosed on Ultrasonography: A Rarest Case Report.

Corpus spongiosum abscess is a rare condition with no case reported as of now diagnosed on ultrasonography (USG). Here, we report a unique case of a 40-year-old Indian male with a 15 days' history of pain and difficulty during micturition. The patient had swelling and erythema in distal 1/3 of the penis. The patient was a known case of type 2 diabetes mellitus. Pain aggravated during micturition, there was no history of any urethral catheterization, trauma, or urethritis. On USG, fluid collection was noted in the corpus spongiosum on the posterior aspect of the distal penile urethra. The abscess was drained percutaneously under ultrasound guidance and was send for culture and sensitivity test. The culture yielded Acinetobacter and the patient was treated with 1 week of intravenous antibiotic according to the culture sensitivity test.

Evaluation of anomalies of major veins of the superficial venous system of lower limb in adults on color doppler: An observational study.

OBJECTIVE: To evaluate the incidence of anomalies in the superficial venous system in lower limb. METHOD: Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. RESULT: (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. CONCLUSION: Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research.

Pentalogy of Cantrell associated with exencephaly and spinal dysraphism: antenatal ultrasonographic diagnosis. Case report.

The pentalogy of Cantrell, a rare syndrome, consists of the defects in the anterior diaphragm, diaphragmatic pericardium, lower sternum and supraumbilical abdominal wall, along with congenital cardiac abnormalities. Till date, only few patients with full spectrum of this syndrome have been reported with only 2 cases showing associated exencephaly and spinal dysraphism. We report extremely rare association of complete pentalogy of Cantrell syndrome with exencephaly and spinal dysraphism on antenatal sonogram and autopsy in a 18 weeks fetus of a 19 year-old primi gravida female.

Ectopic thyroid in duplicated gall bladder: a rare entity. Case report.

Duplication of the gall bladder is a rare anomaly. Ectopic thyroid in a gall bladder is also exceedingly rare with only four cases of ectopic thyroid tissue in the gall bladder reported in English literature. We report the unique case of ectopic thyroid tissue in a duplicated gall bladder in a 51-year-old female with recurrent right upper quadrant pain. Abdominal sonography revealed a duplicated gall bladder with the cystic-solid mass in the septum separating the two gall bladders while subsequent histopathology from the cholecystectomy specimen confirmed ectopic thyroid tissue within the wall of double gall bladder.