What is a fistula x-ray?

The article is professionally consulted by Master, Doctor Nguyen Thanh Nam - Radiologist - Department of Diagnostic Imaging - Vinmec Danang International General Hospital.

X-ray is a common imaging technique, valuable in diagnosing problems in diagnosis and treatment process. So how to take X-ray of the fistula and the methods and handling in case of complications.

Fistula radiograph is a technique that uses a water-soluble iodinated contrast agent injected through the fistula to investigate the location, path, anatomical relationship, size and limitation of the fistula, in order to diagnose the fistula. Accurate diagnosis and help surgeon treat effectively.

2.1. Indication sheet for fistula X-ray The patient must have a request for fistula X-ray before a specialist can conduct the scan.

2.2. Fistula is a procedure performed by a specialist, the manipulations ensure radiation safety principles and achieve high diagnostic efficiency with the support of an electro-optical technician. Before conducting the procedure, the doctor will fully explain the procedure, possible complications and reassure the patient with the methods of handling complications prepared in advance. The most important thing is to declare a history of drug allergies, especially allergies to contrast agents and drugs containing iodine. Because this method uses iodinated contrast agents, if allergic, it will cause complications that affect the results of the scan as well as the patient's health. Because the X-ray method of soft tissue fistula is not related to the gastrointestinal tract, the patient does not need to fast or enema before performing the scan. However, to ensure safety for people at risk, it is necessary to fast for 4-6 hours before the scan. Because the fistula X-ray is a procedure, the patient must sign a consent form to perform the procedure. Patients need to cooperate well with the doctor so that the scanning process goes smoothly, the scan results are more accurate.

3.1. Means of performance Specialized X-ray machine Storage system, film board, cassette. 3.2. Materials used in the imaging process 10mL syringe needle with a capacity of 18-20G type Iodine contrast agent water soluble Skin antiseptic, local anesthetic spray, sedative. Distilled water or physiological saline to dilute the contrast. Protective equipment such as gloves, caps, surgical masks. Set of bean trays, surgical clamps. Cotton and surgical gauze. Medicine box and first aid kit in case of contrast agent accidents. 3.3.Patients lying position Place the patient in prone, supine, inclined or sitting position on the imaging table arbitrarily so that the patient's position must be consistent with the position of the fistula. Clean and disinfect the fistula. Mark a lead letter close to the fistula so that the leak can be located on the screen. 3.4. Approaching the patient's fistula Use a catheter to find the direction of the fistula. Inject about 5 to 10ml of contrast agent into the fistula, with a moderate rate of injection, neither too fast nor too slow. 3.5 Conduct X-ray. Place the patient in the appropriate direction for the fistula. The fistula must be sealed before performing contrast injection to prevent drug reflux into the skin. If the patient's fistula is large, more contrast can be injected to fully detect the fistulas and fistulas. During the procedure, it is especially important to investigate whether there is a leak in the visceral area or the gastrointestinal tract. (For example: anorectal fistula, gastrointestinal fistula after gastrointestinal surgery, retroperitoneal fistula after surgery)

The fistula after contrast enhancement can be observed, which is the solution, the line increases the contrast. May be a simple fistula, like a thread, with sharp edges; but can also have many forms, many branches, nooks, many pockets. The fistula can sometimes be amputated due to solid pus or compression mass. In cases of soft tissue leakage and from lesions of bone origin such as osteomyelitis or osteomyelitis, or from necrotic tumors with superinfection. Fistulas from soft tissue alone are mainly caused by intramuscular abscesses. In the case of fistulas from the gastrointestinal tract or anorectal, this is one of the most complicated types of fistula. Lesions are often recurrent, and fibrotic inflammation makes it difficult to locate the fistula. Not just one fistula but multiple fistulas around the anal area. Fistulas through the wall of the gastrointestinal tract can be easily observed on radiographs. The image shows the internal orifice and the drug deposition in the lumen of the digestive tract. The fistula from the abdomen, the thorax after surgery, following the drains.

If the patient is bleeding, remove the catheter and stop the bleeding immediately with compressive gauze. Aseptic treatment is very important to avoid affecting the health of the patient, but in the case of an infection, it can be prevented with antibiotics. In the event of an allergic reaction to contrast agents, they must be handled in accordance with the procedures for diagnosis and treatment of adverse events issued by the Ministry of Health.

Doctor Nguyen Thanh Nam used to be a Lecturer in Diagnostic Imaging, Hue University of Medicine and Pharmacy with good English and Russian skills and over 10 years of experience in the fields of Diagnostic Imaging.
The method of X-ray fistula is very safe to help patients detect diseases early and accurately. To register for a fistula examination and X-ray at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register for an online examination HERE.
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