Perianal fistula (grade V)
Recurrent fistula in ano twice treated with no relief.
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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.
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.