Perianal fistula: high trans-sphincteric
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Pus discharge from the anus
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Hyperintense fistulous tract extends in the left ischioanal & ischiorectal fossa for about 7 cm, it traverses the external anal sphincter opposite 3 O'clock arching over the puborectalis and below the levator ani muscle, to end in a horseshoe posterior intersphincteric collection measuring 3.0 cm, no side branches noted.
High trans-sphincteric fistula with horseshoe intersphincteric abscess.
Controversy in the diagnosis of this case between "Suprasphincteric" & "High Trans-sphincteric" fistula,
It's usually difficult radiologically to differentiate suprasphincteric fistula from a high transsphincteric fistula. In any event, there is little difference in practical terms because surgical management is similar.
- Halligan S, Buchanan G. MR imaging of fistula-in-ano. Eur J Radiol. 2003;47 (2): 98-107. Pubmed citation