Perianal Fistula MRI Results - Question

what is your drainage like? sometimes you can get an idea of whether its drainage caused by stool or drainage just from the tract based on color, thickness, smell, etc.

I think the MRI is one of the better imaging tools used for examining fistulas, but sometimes they will miss. Also depends on who is looking at them. I know there are also some experienced colo surgeons that don't use them at all and still prefer the old school way of using a probe.

Based on what you are saying, it still sounds like there may still be an internal opening somewhere that hasn't closed up that the MRI may have missed. Only your surgeon would know for sure after another exam.

I would think at the 3 month mark, you should start seeing some improvement.

Hi Dbrookenz, sure you can have that. It is a blind fistula and it is very easy to cure with fistulotomy.
A typical example of a fistula that does not have an internal opening occurs with Pilonidal Cysts.
It can still create continuous drainage and appear as a fistula since the infection does not subside once it is created.
I also have (hopefully had) that - I had a primary fistula connected to an internal opening and a secondary separate fistula extension that is superficial.
However, I do agree with no fistulas comment about MRIs, they may miss the internal opening. You may have a more accurate diagnosis for the internal opening through the use of a 3D endoanal ultrasound. I had (independently taken) both an MRI and an endoanal ultrasound and both tests agreed on the location of the internal opening.

Hi again dbrookenz my friend, great to have you back commenting, although I hope that sooner or later we'll all be seeing goodbye to this forum.
My understanding is that even if it is a superficial fistula, you still have to take it out by fistul (ectomy or otomy). Draining and mushroom just keeps the abscess from reforming.
I fully understand (and obviously share) your frustration (it has been around 7 months for me as well!).
I still believe that the fistula loses in the end, always.
I have recorded my surgery saga on the "Filac Time" thread. It seems to be going OK according to my CRS, but as you can imagine, I have my doubts. I am 23 days past filac surgery and still draining (although significant reduction has occured and the draining is not the same consistency or "quality" haha, sorry no other way to describe).
At the end of the day, we are looking for some improvement, even if it's baby steps. For example, if a fistula becomes smaller or more superficial through a surgery (like it could very well be the case with you if it has indeed become superficial), we have won a battle. These small incremental steps lead to winning the war!!!

Post Edited (Dimitri71) : 11/17/2017 2:07:46 AM (GMT-7)

i've heard the same thing regarding the flap. which is why it seems a lot of surgeons move on to another type of surgery after a failed flap. i would go for LIFT next. i had one which failed. but one of pluses of LIFT is that you can attempt multiple times without any risk of incontinence or diminishing returns. there are studies that show that the percentage of success actually goes up during your second LIFT attempt. (similar to FILAC as well). i'm hoping that is the case for me as well. although my current streak seems to say otherwise. You could try Filac as well, unless you are in the US. Filac is hard to find within the US right now, but seems to be readily available in europe and asia.

it's strange that your seton bothers you that much - especially for just a draining seton and not a cutting seton. To be honest, I've had mine in for a long time and even after the first surgery I didn't even notice that was there. still don't. It must be the location of the fistula and where it tracks to.

i know what you are going through. i've had to wait over a year to get my first crack at a LIFT - only to have it fail within 5 days. I suppose it's better to know quickly than have to wait several months to find out. but still demoralizing for sure. i too feel like i've taken two steps back and trying to get back to square one again so I can try the LIFT one more time.

For the record, I had a very obvious perianal fistula and had an MRI in March which showed *nothing*--no fistula at all. Mine was superficial (did not go through any muscle), so much so that my CRS and GI could see both the internal and external openings easily without any scopes, etc. My MRI also showed only "mild" inflammation "consistent with UC" but in truth my CRS informed me it was one of the worst cases he had seen and pathology showed it was undoubtedly Crohn's.

I've known of plenty of women with recto-vaginal fistulas that could not be diagnosed via MRI and were missed or difficult to diagnose upon examination.

All this to say, MRI's are a useful tool but they cannot be relied upon to give a diagnosis.