Perianal fistula

Case contributed by Utkarsh Kabra
Diagnosis certain

Presentation

Right perianal discharge

Patient Data

Age: 35 years
Gender: Male
mri

Linear hyperintense fistulous tract measuring approx. 4 cm in length in the right posterior perianal region.

External opening is seen to the right of midline. 

The tract is seen to course laterally and superiorly for a length of approx. 9 mm and then courses anteriorly, superiorly and slightly medially in intersphincteric planes with the internal opening at approx. 6 o’clock position. 

Small branching tract is seen at the posteroinferior aspect, measuring approx. 8.6 mm in length with the external opening to the right of midline. 

A note is made of thickening and hyperintensity of right hamstring tendons with mild marrow edema in ischial tuberosity – likely enthesopathy.

Case Discussion

Findings are suggestive of an intersphincteric perianal fistula with a small branching tract.

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