Perianal fistula: high trans-sphincteric

Case contributed by Dr Dalia Ibrahim

Presentation

Pus discharge from the anus

Patient Data

Age: 30 years
Gender: Male

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.

Opinion:

High trans-sphincteric fistula with horseshoe intersphincteric abscess.

Case Discussion

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.

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