High transphincteric perianal fistula with two setons

Case contributed by Yaïr Glick
Diagnosis certain


Re-evaluation of perianal fistula.

Patient Data

Age: 45 years
Gender: Male

Left high transphincteric perianal fistula at 4 o'clock with a distal bifurcation, with one end opening onto the natal cleft and the other onto the medial posteroinferior aspect of the left buttock. Two setons have been inserted, one through each cutaneous fistula, both passing though the internal opening into the rectal lumen to end outside the anal verge.

Minimal amount of hydrocele on both sides of the scrotum.

Case Discussion

MRI done for demonstrating the entire extent of the fistula and ruling out a perianal abscess. No abscess demonstrated.

A draining seton is essentially a string (e.g. surgical suture or silicone) placed along a perianal fistula for facilitating drainage and preventing premature cutaneous closure.

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