CLINICAL CHARACTERISTICS OF PATIENTS WITH COLONIC FISTULAS AND COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF RADIOLOGICAL EXAMINATION METHODS

Authors:

Abstract:

Intestinal fistulas are clinically challenging because complex tracts and associated inflammatory complications may be difficult to characterize before treatment. This retrospective clinical-radiological study included 94 patients with fistulas and compared non-contrast with contrast-enhanced computed tomography while also examining clinical and radiological associations. Fistulas were detected in 67 patients (71.3 %) by non-contrast computed tomography and in 87 (92.5 %) by contrast-enhanced computed tomography (p<0.001). Contrast enhancement was associated with higher sensitivity (92.5 % vs 71.3 %), specificity (88.2 % vs 64.7 %), positive predictive value (94.3 % vs 79.1 %), negative predictive value (83.7 % vs 54.5 %), accuracy (90.4 % vs 69.2 %), and area under the receiver operating characteristic curve (0.91 vs 0.71). Significant correlations were found between fistula length and abscess size, intestinal wall thickness and fistula diameter, and Crohn’s disease and fistula severity. Contrast-enhanced computed tomography therefore provides more informative pre-treatment assessment of intestinal fistulas and their complications.

Keywords:

intestinal fistula computed tomography contrast enhancement diagnostic accuracy abscess Crohn’s disease

References:

1. Abuliezi D, Luo Y, Huang Q, Yang Y, Zhuang H. Trans-Fistula Contrast-Enhanced Ultrasound in Diagnosing a Complex Anal-Bartholin-Perineal Fistula of Crohn's Disease: A Case Report. J Clin Ultrasound. 2026 Mar-Apr;54(3):767-770. doi: 10.1002/jcu.70111.
2. Bloomfield J, Haddad B, Canlorbe G, Touboul C, Lecarpentier E, Dabi Y. Long-term results of the Musset surgical technique in the treatment of recto-vaginal fistulas. Int J Gynaecol Obstet. 2026 Mar;172(3):1656-1664. doi: 10.1002/ijgo.70532.
3. Boruah DK, Hazarika K, Ahmed H, Borah KK, Borah S, Malakar S, et al. Role of Diffusion-Weighted Imaging in the Evaluation of Perianal Fistulae. Indian J Radiol Imaging. 2021 Jan;31(1):91-101. doi: 10.1055/s-0041-1729673.
4. Ding TJ, Wang L, Chen T, Yu T, Chen CJ, Liu JT. A High Sensitivity and Anti-Scaling Surface Plasmon Resonance Sensor for Early Screening of Colorectal Cancer. Biosensors (Basel). 2026 Aug 3;16(8):418. doi: 10.3390/bios16080418.
5. Dsouza R, Griner S, Mandava N. Anorectal Fistula. [Updated 2026 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560657/
6. Emile SH, Garoufalia Z, Aeschbacher P, Horesh N, Gefen R, Wexner SD. Endorectal advancement flap compared to ligation of inter-sphincteric fistula tract in the treatment of complex anal fistulas: A meta-analysis of randomized clinical trials. Surgery. 2023 Aug;174(2):172-179. doi: 10.1016/j.surg.2023.04.004.
7. Flor N, Scolari S, Liedenbaum M, Maconi G, Colombo F, Maffioli A, et al. Colonic Acquired Fistulae: The Potential of CT Colonography. Academic Radiology, 2022; 30, 959-965.
8. Gaertner WB, Burgess PL, Davids JS, Lightner AL, Shogan BD, Sun MY, et al; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2022 Aug 1;65(8):964-985. doi: 10.1097/DCR.0000000000002473.
9. Garg P, Bhattacharya K, Yagnik VD, Mahak G. Recent advances in the diagnosis and treatment of complex anal fistula. Ann Coloproctol. 2024;40(4):321-335. DOI: https://doi.org/10.3393/ac.2024.00325.0046.
10. Granieri S, Sessa F, Bonomi A, Paleino S, Bruno F, Chierici A, et al. Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence. BMC Surg. 2021 May 27;21(1):265. doi: 10.1186/s12893-021-01272-6.
11. Jayne DG, Scholefield J, Tolan D, Gray R, Edlin R, Hulme CT, et al. Anal fistula plug versus surgeon's preference for surgery for trans-sphincteric anal fistula: the FIAT RCT. Health Technol Assess. 2019 May;23(21):1-76. doi: 10.3310/hta23210.
12. Ladke P, Mitra K, Dhok A, Dhawan S, Potdukhe P. Colo-Vesical Fistula: Relevance of Conventional Radiology in the Modern Era. Cureus. 2023 Mar 12;15(3):e36037. doi: 10.7759/cureus.36037.
13. Lu MY, Wang J, Wang ZC, Cai ZL, Liang N, Shi R. Diagnosis and treatment for anal fistula: a systematic review of clinical practice guidelines and consensus statements. Front Surg. 2025 Jul 2;12:1566130. doi: 10.3389/fsurg.2025.1566130.
14. Sohrabi M, Bahrami S, Mosalli M, Khaleghian M, Obaidinia M. Perianal Fistula; from Etiology to Treatment - A Review. Middle East J Dig Dis. 2024 Apr;16(2):76-85. doi: 10.34172/mejdd.2024.373.
15. VanBuren WM, Lightner AL, Kim ST, Sheedy SP, Woolever MC, Menias CO, et al. Imaging and Surgical Management of Anorectal Vaginal Fistulas. Radiographics. 2018 Sep-Oct;38(5):1385-1401.
16. Wu SZ. Surgeon oriented reporting template for magnetic resonance imaging and endoanal ultrasound of anal fistulas enhances surgical decision-making. World J Radiol. 2024 Dec 28;16(12):712-716. doi: 10.4329/wjr.v16.i12.712.

Publication:

«World of Medicine and Biology» Vol. 22 No. 97 (2026), pp. 80-85
UDC 616.34-007.253-073.756.8

DOI:

https://doi.org/10.26724/2079-8334-2026-3-97-80-85