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CT scan showed perianal cysts. MRI showed clear. Having pain. What does the reports says?

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Practicing since : 2007
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I had a perianal cysts which showed on a CtTscan taken for other reasons. They decided to invistigate as a precaution and to do a needle excision for biopsy. In the process they infected it and 3 weeks later and immense pain they operated to remove a 3" abcess. It was packed daily to heal. 7 months later I had pressure pain but thought nothing of it. A year later the scar started to open and exude. They did another MRI after 12 months and told me it was clear, however, I told them of the symtons and they decided to operate on the now identified sinus, which they thought was on the suraface. It transpired it went back nearly to the original site but had not originally been spotted on the MRI (soon identified when I told them of the symptons. This did not heal from the bottom - up (sideways) and repeatedly bled (they had taken me back to theatre after the 2nd op as it was bleeding profusely). They then did a 3rd op and sent me home with a vac pump - this did not work and the sinus started to heal sideways again and left a sinus above the original sight (5cms deep). District Nurses are trying hard to keep the top open until I have another MRI this week. What should I do/say. I have no faith in their interpretation of the MRIs now, or in another op? A simple needle excision has involved me in nearly two years of pain, ops and still unresolved. Affected my quality of life, health and family commitments.
Posted Tue, 16 Oct 2012 in X-ray, Lab tests and Scans
Answered by Dr. Ganesh Sanap 4 hours later

You had simple perianal cyst which got complicated. Despite of the advancement in preoperative imaging and surgical techniques, recurrence is not uncommon in this disease entity.

Are you diabetic, when was the last time the screening done? There may be chance of infection during the operation or after the procedure even after following the principles of wound management.

Regarding MRI interpretation, sinus need to be open at the time of scan so that it can be identified. There is another option for diagnosing the complete tract of sinus, SINOGRAM, in which XXXXXX is pushed through sinus opening and x-rays taken , which will delineate the complete track of sinus. Also ask your doctor to do MRI sinography rather than simple MRI, it will be useful. Just go for this last investigation.

A culture and sensitivity of discharge is needed to start antibiotics, as there is no antibiotic in your prescription.

Hope i have cleared your query, feel free to ask anything else.

Thanking you.

Above answer was peer-reviewed by
Follow-up: CT scan showed perianal cysts. MRI showed clear. Having pain. What does the reports says? 14 hours later
I will check what sort of MRi has been ordered - is a sinograph MRI commonly done in the UK. Is it reasonable to expect that radiography or the consultant should have seen the sinus in the MRI taken in March 2012 after the original op, especially as it was so XXXXXX and not on the surface as they first thought when I told them the symptons. As soon as I told the consultant the problem he scanned the MRI and very soon said 'there it is' and showed me a bright white light (no density) - I feel they should have seen this when they were checking the mri to confirm there were no problems with the first op (Feb 2011).

Presuming they will now need to open the wound again, what are my options re healing techniques and how many times can it be reasonable to open the same wound (this will be 4 times - 1 last year and 3 within the last 3 months).
Answered by Dr. Ganesh Sanap 16 minutes later

Thanks for writing back XXXXXX

I thought it was not diagnosed before on MRI. As per your information it is diagnosed beforehand, so need of sinogram or MRI. Difficult to say but ball is in court of surgeons, either you have to consult another team of surgeons (also radiologist) or ask your specialist for complete sterile conditions for operation.

Regarding healing of wound and reoperation, there is no other option except dedicated dressing and also evaluation of all blood components necessary for healing like blood zinc, vit C level, etc.

Also ask for culture and sensitivity of discharge.

Hope you got your answer.

Thanking you.
Above answer was peer-reviewed by
Follow-up: CT scan showed perianal cysts. MRI showed clear. Having pain. What does the reports says? 1 hour later
Thanks. to clarify; the MRI in Marvh was to ascertain that the original op had removed all the cyst and subsequent abcess and that the wound was OK. They said it was all clear until I met and told them the scar was opening and exuding - when they then looked again and saw a sinus (originally they thought it was on the surface but when re-operating it was a very XXXXXX sinus, nearly back to the original site). When I asked why this had not been identified and I was give no satisfactory answer. This is why I question the credibility of this MRI/interpretation and whether it should have been possible to see it.

I do not have diabetes (not sure of the implications).

Re a new operation - thanks for your suggestion. However, how many times can this site be re-operated on without risk (apart from the obvious - infection).
Answered by Dr. Ganesh Sanap 2 hours later

Your problem is conversion of cyst into sinus. When surgeon opens any wound it’s his job to search the deepness of that wound either by finger or any other instrument. Direct inspection and opening of any wound cannot substitute any other investigation, that’s why I asked you if possible change the team of consultant.

Unfortunately now you have to undergo operative procedure or dressing until wound heals, without any risk, except uncomfortableness.

As there is no other option, I am repeating again to do culture and sensitivity of discharge and then take antibiotics accordingly.

Hope now you are satisfied with my answer.

Thanking you.

Above answer was peer-reviewed by
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