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Anovaginal and Rectovaginal Fistulas

Endoluminal Sonography Versus Endoluminal MR Imaging

Jaap Stoker1,2, Elena Rociu1,2, W. Ruud Schouten3 and Johan S. Laméris1

1 Department of Radiology, Academic Medical Center, University of Amsterdam, P. O. Box 22700, 1100 DE Amsterdam, The Netherlands.
2 Department of Radiology, University Hospital Rotterdam Dijkzigt, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
3 Department of Surgery, University Hospital Rotterdam Dijkzigt, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.



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  		Fig. 1. —Axial endosonogram obtained in healthy 30-year-old volunteer with 7.5-MHz transducer shows hypoechoic internal sphincter (I) and hyperechoic external sphincter (arrows). A = anterior.

 


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  		Fig. 2. —Endosonogram obtained with 7.5-MHz transducer in 38-year-old woman with obstetric trauma shows anovaginal fistula with echogenic air bubbles (arrowheads) in track.

 


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  		Fig. 3. —Endoanal axial T2-weighted turbo spin-echo MR image obtained in healthy 24-year-old volunteer shows internal sphincter (I), external sphincter (E), vagina (V), and anovaginal septum (S).

 


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  		Fig. 4. —Endoanal axial three-dimensional proton density—weighted gradient-echo MR image obtained in 42-year-old woman with previous obstetric trauma shows low anovaginal fistula (arrows) partly fluid-filled (hyper-intense) and partly fibrous or collapsed (hypointense). External sphincter (E) and anterior external sphincter defect (curved arrows) are also visualized.

 


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  		Fig. 5. —Endoanal axial T2-weighted turbo spin-echo MR image obtained in 28-year-old woman reveals hypointense collapsed track (arrow) coursing from anus to vagina through anovaginal septum with multiple hyperintense vessels.

 


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  		Fig. 6. —Endoanal axial T2-weighted turbo spin-echo MR image in 46-year-old woman reveals hyperintense vascular structure (arrow) misinterpreted as track without discernible anal opening. Course of structure, which is continuous into intersphincteric space (arrowhead), indicates vascular origin of this structure.

 

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