P1011 - Rapid Transperineal Ultrasound Evaluation For Perianal Abscess Is Comparable To Pelvic MRI

Benjamin D. McDonald, MD, PhD¹, Joelle St-Pierre, MD, PhD¹, Jeremy A. Klein, MD², Natalie K. Choi, BA¹, David T.. Rubin, MD, FACG^1
1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL; ²University of Chicago Medical Center, Chicago, IL

Introduction: Perianal Crohn’s disease (pCD) is a debilitating form of Crohn’s disease (CD) that impacts approximately 25% of patients with CD. The diagnosis of a perianal abscess, a common complication of pCD, is often by pelvic MRI which is not universally tolerated by patients, may require intravenous contrast, is costly, and can lead to a time delay between symptom onset and scheduling of definitive surgical therapy. Cost-conscious approaches that streamline patient care are greatly needed. Several European centers use transperineal ultrasound (TPUS) to rapidly diagnose perianal pathology, but this imaging modality has not been routinely utilized in the United States.

Case Description/Methods: A 26-year-old man with a 1-year history of Crohn’s disease of the colon and a previous perianal abscess currently treated with mesalamine presented to establish care at our Inflammatory Bowel Disease (IBD) Center. He did not describe perianal symptoms at the time of his visit and a careful perianal exam by an expert IBD clinician was notable only for a soft, non-inflamed skin tag. Five days following his visit, he contacted his physician describing rapidly developing perianal pain and swelling, but without fever. We performed same day TPUS and identified a left/posterior gas-containing collection with extension toward the patient’s right side (horse-shoe anatomy; Figure A) and without connection to the skin. To validate the TPUS findings, the patient underwent pelvic MRI 3 days later which confirmed a perirectal abscess (Figure B). The patient underwent exam under anesthesia by our colorectal surgeon that included drainage of the abscess and placement of a temporary drain.

Discussion: Intestinal ultrasound (IUS) is a rapidly evolving imaging modality now used at many IBD centers across the world. Clinicians perform IUS in place of cross-sectional imaging or colonoscopy to evaluate disease activity, response to therapy, and to monitor disease control. However, given the need for additional ultrasound transducers and specialized training, TPUS has not yet been widely adopted. This case demonstrates the ability of TPUS to quickly evaluate patients with perianal symptoms to expedite definitive management. We propose expansion of availability of TPUS and encourage investment in training and equipment to provide it more broadly to patients.



Disclosures:


Benjamin D. McDonald, MD, PhD¹, Joelle St-Pierre, MD, PhD¹, Jeremy A. Klein, MD², Natalie K. Choi, BA¹, David T.. Rubin, MD, FACG¹. P1011 - Rapid Transperineal Ultrasound Evaluation For Perianal Abscess Is Comparable To Pelvic MRI, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.