Perianal fistula (grade V)

Case contributed by Varun Babu
Diagnosis certain

Presentation

Recurrent fistula in ano twice treated with no relief.

Patient Data

Age: 50 years
Gender: Male
mri
This study is a stack
Sagittal
T2 fat sat
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Coronal T2
fat sat
This study is a stack
Axial
T2
This study is a stack
Axial
T1
This study is a stack
Axial
DWI
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Info

Right ischioanal abscess with two large tracks extending in the intersphincteric plane in a horseshoe pattern from 2 to 11 o clock position extending supralevator and lying perirectal. Diffuse accompanying perianal subcutaneous edema. 

Case Discussion

This patient could barely sit and clearly repeated episodes of treatment have not been good enough to solve his recurring problem. Long standing recurrent fistulae result in abscess formation, that eventually spreads, in this case extending supralevator into a horseshoe pocket around rectum. 

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