F ISTULOGRAM /
SINOGRAM
A fistulogram is an x-ray procedure used to view a fistula, an abnormal
passage between two or more parts of your body that often drains out of
your skin.
A sinogram is a similar procedure done to assess a sinus, an abnormal
passage or cavity that originates or ends in one opening, often on the skin.
Contrast material is used to help fill the track and determine what parts
of your body are involved.
Both examinations are used to assess and diagnose the size and shape of
fistulas and sinuses and any related abscess and/or infection.
INDICATION
S
Osteomyelitis
To see abnormal passage on cavity
Swelling and tunnel creation after injury
To see the shape and size of sinus or fistula.
To evaluate any fistula formation between surrounding tissue and sinus.
Development of a sinus or fistula
Route or extent of the sinus or fistula
In order to figure out which organs are involved.
CONTRAINDICATIONS
Allergy to contrast media
Suspected pregnancy
Severe localized infection.
EQUIPMENT
Fluoroscopy unit with spot film device
Catheter or cannula (18G, 20G, 22G)
Local anesthesia ( lignocaine)
Water soluble contrast media
Normal saline
Dressing material (Gauze, sterile towel, cotton swabs, sterile gloves and
scissors).
Disposible syringe ( 10ml or 20ml)
Skin antiseptic solution ( povidone iodine, spirit, savlon)
PATIENT PREPARATION
Ask patient if she is pregnant.
On the day of examination describe the whole procedure to the patient
Not to eat and drink two hours prior to the examination.
Obtain consent from the patient
CONTRAST
:
A water-soluble contrast medium should be used (e.g. Urografin 150).
PRELIMINARY FILM:
A preliminary film is taken to exclude the presence of a radioopaque
foreign body.
TECHNIQUE:
The patient lies on the fluoroscopic table with the opening of the sinus or
fistula uppermost and is made as comfortable as possible.
The skin surrounding the area is prepared using a suitable antiseptic preparation
and sterile towels are placed around the opening.
An appropriate-size Foley catheter is then inserted into the orifice of the sinus.
The balloon may be inflated inside the sinus to prevent retrograde flow.
Alternatively, the balloon may be inflated outside the sinus and
pushed to the skin
The contrast medium is injected carefully under fluoroscopic
control.
Fluoroscopic ‘grab’ images supplemented by proper exposures are
taken as required, including tangential views
Any contrast media left in the sinus will be absorbed into your blood,
collected by your kidneys and excreted when you urinate.
The contrast media will not affect the color of your urine.
If you develop hives or itching, or experience any difficulty
swallowing or breathing, contact your physician or go to the
Emergency Department of the hospital nearest you.
AFTER CARE
Patient should be shifted into the recovery or dressing room.
Catheter is removed and bandage is applied over the puncture side
to stop bleeding.
Patient is advised to take bed rest for two days
Patient should be advised to take antibiotics to avoid any post-
procedure infection.
C O M P L I C AT I O N S
Minor pain, bruising and/or infection from the tube insertion. This
may require treatment with antibiotics
Bruising is more common if you have been taking blood
thinning drugs, such as warfarin, aspirin, clopidogrel.
Less common risks and complications
Allergic reaction to the contrast. This could result in a rash,
hives, itching, nausea, fainting or shortness of breath. Medication
may be given to relieve this.
o Perforation of sinus
o Bruising or infection from tube insertion
o May require treatment with antibiotic
o Allergic reaction to contrast
o Rash, itching, nausea and shortness of breath
Pilonidal sinus results from a skin and subcutaneous tissue infection
