Complex transsphincteric fistula with supralevator extension
Referred with perianal discharge resistant to antibiotic therapy.
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Complex perianal fistula originating at 6 o'clock of the anal canal. It continues as a horseshoe intersphincteric abscess and is continuous transsphincterically with the left ischiorectal and ischioanal spaces at 5 o'clock and drains at 3 o'clock on the perianal skin.
Length of fistulous tract is about 63 mm.
Additionally, an accessory branch from this fistula extends above the left levator ani muscle, consistent with a supralevator component.
Complex transsphincteric fistula with supralevator extension and intersphincteric abscess.