fistulografie

Fistulography is a radiographic technique used to map fistulous tracts by introducing a contrast agent into the fistula opening and visualizing the course with X-ray fluoroscopy. The study aims to delineate the tract, its connections to internal or adjacent structures, and any secondary or abscess cavities, thereby aiding diagnosis and preoperative planning.

The examination is typically performed under fluoroscopic guidance. After identifying and cleaning the external opening, a fine catheter or cannula is inserted into the fistulous tract and a water-soluble iodinated contrast is injected gradually while radiographs or fluoroscopic sequences are acquired in multiple projections. The tract’s length, direction, any branching, presence of an internal opening, and connections to cavity spaces are assessed. In complex or pelvic fistulas, CT or MR fistulography may provide additional information.

Fistulography is most often used for anorectal fistulas but can also evaluate cutaneous, urogenital, or intra-abdominal fistulas. It complements clinical examination and other imaging modalities such as MRI, CT, endoscopic ultrasound, or ultrasound. Its findings help define the anatomy for surgical planning and assess fistulous connections.

Limitations include incomplete opacification of narrow or occult tracts, occasional poor visualization of deep pelvic fistulas, radiation exposure, and potential risk of infection or contrast reaction. Because MRI and CT-based fistulography can offer superior sensitivity for complex disease, fistulography is often reserved for specific indications or when other modalities yield inconclusive results.