Investigating perianal pain of uncertain cause

doi:10.1136/bmj.39455.393299.AD

BMJ 2008;336:387-389 (16 February), doi:10.1136/bmj.39455.393299.AD

Practice

Rational imaging

Investigating perianal pain of uncertain cause

Rebecca Greenhalgh, radiology specialist registrar¹, C Richard Cohen, consultant colorectal surgeon¹, David Burling, consultant radiologist², Stuart Andrew Taylor, senior lecturer in radiology and honorary consultant radiologist¹^,3

¹ University College Hospital, London NW1 2BU, ² St Mark’s Hospital, Harrow HA1 3UJ, ³ University College London, London

Correspondence to: S A Taylor stuart.taylor@uclh.nhs.uk

This article explores the radiological investigations availableto diagnose perianal pain of unknown cause, with particularreference to perianal sepsis

The first 150 words of the full text of this article appear below.

Learning points

Imaging plays an important role in elucidatingthe cause of anal pain when the diagnosis is not clinicallyapparent

Endoanal ultrasound is an increasingly available,relatively inexpensive, quick and safe technique providing highresolution images of the anal sphincter complex, and intersphinctericspace, but it is limited by a relatively small field of view

Magneticresonance imaging, although not universally available, affordsmuch greater anatomical coverage than endoanal ultrasound andcan also image the perirectal tissues and lumbar-sacral spine,facilitating diagnosis of conditions beyond the anal canal

Inthe case of perianal sepsis, preoperative magnetic resonanceimaging may be indicated in clinically suspected complex orrecurrent disease to guide surgery, reducing the risk of futurerecurrence

The patient

A 29 year old woman presented with constipation, constant perianalburning, and pain on defecation. Digital rectal examinationwas uncomfortable with induration in the right posterior quadrant,but there was no evidence of anal . . . [Full text of this article]