Pastient presents with worsening perianal pain on a background of AML and Hartman's operation.
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There is an irregular T2 bright transphincteric fistulous tract communicating the midportion of the anal canal at 12 o'clock to the distal aspect of the posterior inferior vaginal wall, just above the transverse perineal muscles. Its relation and possible opening into the perineal skin is difficult to assess and should be correlated clinically. The surrounding inflammatory changes do not show soft tissue collections.
The distal portions of the rectum have unremarkable appearances for this protocol.
There is a small amount of free fluid in the pouch of Douglas. The uterus is anteverted, has normal size, and unremarkable signal intensity; there are multiple small Nabothian cysts in the cervix. The bladder shows a small urachus remnant but is otherwise normal for this protocol.
Right adnexa 2.1 cm likely hemorrhagic cysts demonstrated. No pelvic lymphadenopathy.
This case illustrates a T2 bright tract between the anal canal and distal posterior wall of the vagina in keeping with an anovaginal fistula.