From the Research
CT fistulography is the best imaging modality for evaluating enterocutaneous fistulas. This technique involves injecting water-soluble contrast material through the external fistula opening, followed by CT scanning, which provides detailed information about the fistula tract, its origin, course, and any associated complications 1. MRI is an excellent alternative when radiation exposure is a concern, offering superior soft tissue contrast without ionizing radiation. Conventional fistulography (fluoroscopy) can be useful but lacks the cross-sectional detail of CT. Ultrasound may help identify superficial tracts or abscesses but has limited depth penetration.
Key Benefits of CT Fistulography
- Accurately delineates the anatomy of the fistula
- Identifies the intestinal segment involved
- Detects any associated abscesses or collections
- Helps determine if there are multiple tracts or communications
- Provides comprehensive information that guides treatment decisions for enterocutaneous fistulas
Comparison with Other Imaging Modalities
- MRI: excellent alternative when radiation exposure is a concern, offering superior soft tissue contrast without ionizing radiation 1
- Conventional fistulography (fluoroscopy): lacks the cross-sectional detail of CT
- Ultrasound: limited depth penetration, but may help identify superficial tracts or abscesses 2
- CT is preferred because it is relatively quick, widely available, and provides comprehensive information that guides treatment decisions for enterocutaneous fistulas 3
Clinical Implications
The choice of imaging modality is critical in the management of enterocutaneous fistulas, as it can significantly impact morbidity, mortality, and quality of life. CT fistulography is the recommended imaging modality due to its ability to provide detailed information about the fistula tract and associated complications, which is essential for surgical planning and management 1.