Peri-anal fistula: trans-sphincteric

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

Perianal pain and swelling with discharge of pus and blood.

Patient Data

Age: 50 years
Gender: Male
This study is a stack
Axial
T1
This study is a stack
Coronal
T1
This study is a stack
Axial T2
fat sat
This study is a stack
Coronal T2
fat sat
This study is a stack
Sagittal
T2
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
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Info
  • a right perianal thick-walled trans-sphincteric fistulous tract about 9 cm long is seen with its opening of about 5 o'clock. The fistulous tract ascends upwards and then curved medially to pierce the the external and internal anal sphincters to open within the posterior wall of the anal canal.
  • mild local peri-anal sepsis with enhancing inflammatory tissue is seen around the fistulous tract with local inflammatory changes of the right ischioanal and ischiorectal fossae.
  • intact levator ani and  pelvic floor muscles.  

Case Discussion

Grade III right peri-anal trans-sphincteric fistulous tract with inflammatory changes of the right ischio-anal and ischiorectal fossae.

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