Presentation
Patient with a history of recurrent perianal fistula is under protocol for a new surgical reintervention.
Patient Data
In the perianal region, a tortuous-looking fistulous tract is identified at the 12 o'clock position, with hyperintense behaviour on T2. It runs caudally between the internal and external anal sphincters towards the ischioanal fossa, without the presence of a collection.
There is a wrap-around artefact on the "axial T2 HASTE fat sat" and "axial T1 VIBE" sequences.
Case Discussion
Perianal fistulas are abnormal communications between the anal canal and the perirectal spaces, which may or may not be associated with a collection. MRI is the preferred study for patients with complex fistulas or to assess and identify anatomical aspects prior to surgical intervention.
In this case, we observe a simple grade 3 transsphincteric fistula according to the classification of St James's University Hospital, which crosses two layers of the sphincter complex, meaning it crosses the external anal sphincter and reaches the ischioanal fossa.
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