Background Information:

What are the other Names for the Procedure?

• Sinogram

What is Fistulogram radiology procedure? (General Explanation)

• A Fistulogram is an advanced imaging technique that uses continuous, real-time X-rays (fluoroscopy) to evaluate the following abnormal tracts
  • Fistula: It is an abnormal connection between two parts of the body
  • Sinus: It is an abnormal passage that ends in an opening (commonly on the skin)
• The examination uses a contrast agent (commonly barium) to follow the abnormal tracts to determine their size, shape, and location

What part of the Body does the Procedure involve?

The part of the body will vary depending upon the location of the abnormal connection being evaluated.

Why is the Fistulogram radiology procedure Performed?

A Fistulogram radiology procedure is used to determine the shape, size, and direction of abnormal tracts, namely fistulas and sinuses.

What are the Alternative Choices for the Procedure?

In some cases, contrast-enhanced computed tomography (CT) scanning can help identify fistulas.

What is the Equipment used? (Description of Equipment)

The following may be used for an Fistulogram radiology procedure:

• Continuous X-ray’s machine (fluoroscopy), which consists of tubes that generate X-rays and a screen that resembles a computer monitor, to display the results to the radiologist in real-time
• Specialized digital film to capture the image generated from X-rays

What are the Recent Advances in the Procedure?

There are no recent advances to a Fistulogram radiology procedure.

What is the Cost of performing the Fistulogram radiology procedure?

The cost of a Fistulogram procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Fistulogram and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Lee, J. & Stein, S. (2010). Radiographic and Endoscopic Diagnosis and Treatment of Enterocutaneous Fistulas. Clinics In Colon And Rectal Surgery, 23(03), 149-160. doi:10.1055/s-0030-1262982 (accessed on 2/14/2017)

Prior to Fistulogram radiology procedure:

How does the Fistulogram radiology procedure work?

X-rays, produced by the machine, either pass through or are deflected by parts of the body.

• If most of the X-rays pass through a structure, it appears black (such as air-filled lungs)
• If a majority of the X-rays are deflected, it appears white (as in bones)
• Many structures (tissues usually) will appear in shades of grey
• The use of the contrast agent helps the abnormal tracts appear more like bones on the X-ray film

Based upon a visual examination, the radiologist or physician makes an interpretation of the image.

How is the Fistulogram radiology procedure Performed?

The procedure is performed in the following manner:

• The individual is positioned on the examination table with the X-ray machine focused on the abnormal tract that is to be evaluated
• It may be necessary to insert an intravenous line (IV) prior to the procedure, to give pain medication or sedation during the procedure
• The area around the abnormal tract is cleaned and draped to prevent contamination by bacteria
• If necessary, a local numbing medicine will be injected near the area
• Using plastic tubing (catheter) and a guidewire, the radiologist accesses the abnormal tract and begins injecting the contrast agent
• X-ray images are taken as the contrast agent flows through the abnormal tract
• Once the abnormal tract has been completely imaged, the procedure is complete and the area cleaned

Where is the Procedure Performed?

A Fistulogram is performed as an inpatient or outpatient procedure at a hospital, depending on the specific indication (cause of concern).

Who Performs the Procedure?

The Fistulogram radiology procedure is performed by a radiologist or a radiology technologist, under the supervision of a radiologist.

How long will the Procedure take?

The duration of a Fistulogram procedure can vary greatly. It depends on the size and course of the abnormal tract.

Who interprets the Result?

A radiologist interprets the results of the images and conveys them to the healthcare provider, who in turn informs the patient.

What Preparations are needed, prior to the Procedure?

The following preparations are needed prior to a Fistulogram radiology procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Patients should inform their physician, if they are allergic to any medications, especially to the contrast given during the procedure
• Women should inform their physicians if they are breastfeeding, pregnant, or if there is a chance that they might be pregnant
• The patient may be asked to avoid eating or drinking several hours before the test

What is the Consent Process before the Procedure?

A physician will request your consent for the Fistulogram procedure using an Informed Consent Form.

Consent for the procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this procedure?

Following are the benefits of the procedure:

• It is less-invasive than surgical exploration
• The technique provides real-time images

Following are the risks of the procedure:

• As with any X-ray examination, there is a very small chance of developing cancer with repeated and excessive exposure to radiation
• X-rays can harm a developing fetus and should be avoided during pregnancy
• Rarely, allergic reactions to the contrast agent used in the procedure may occur

What are the Limitations of the Fistulogram radiology procedure?

In some cases, a Fistulogram radiology procedure may not adequately assess the abnormal tract, requiring the individual to undergo additional and/or more invasive procedures.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is Fistulogram procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Fistulogram radiology procedure:

What is expected during the Fistulogram radiology procedure?

The following may be expected during the procedure:

• Manipulation of the catheter in the abnormal tract may be painful or uncomfortable
• The contrast material may give a warm sensation while being injected
• If a local numbing medication is given, a small poke with the needle and a burning sensation may be felt, before the area becomes numb.  Once the area is numb, no pain will be felt, but one may continue to feel a sensation of pressure

What kind of Anesthesia is given, during the Procedure?

No anesthesia is given during a Fistulogram radiology procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally invasive one, the blood loss involved is minimal.

What are the possible Risks and Complications during the Fistulogram radiology procedure?

• As with any X-ray examination there is a small chance of developing cancer with excessive and repeated radiation exposure
• Rarely, allergic reactions to the contrast agent may occur

What Post-Operative Care is needed at the Healthcare Facility after the Fistulogram radiology procedure?

Generally, no additional care is need at the Healthcare Facility after a Fistulogram radiology procedure.

After the Fistulogram radiology procedure:

What is to be expected after the Fistulogram radiology procedure?

It is common to see mild bleeding or bruising immediately following the procedure. One should be able to resume normal activities within 24 hours.

When do you need to call your Physician?

Do contact the physician in case of the following:

• If you begin to experience an allergic reaction
• Severe pain
• A large amount of blood is leaking form the abnormal tract

What Post-Operative Care is needed at Home after the Fistulogram radiology procedure?

No post-operative care is needed following a Fistulogram radiology procedure.

How long does it normally take to fully recover, from the Procedure?

Generally, no recovery time is needed following a Fistulogram radiology procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Fistulogram radiology procedure does not involve the removal of any body tissue. 

When should you expect results from the pathologist regarding tissue taken out during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Fistulogram radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Fistulogram procedure is performed.