Pus and blood oozing from a left perianal opening.
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A thick-walled sinus tract traverses the left ischioanal fossa for 8 cm, piercing the external anal sphincter at 6 o’clock and crossing the midline to continue for 3 more cm between the external and internal anal sphincters to end blindly to the right of midline, around the anal canal with no definite MRI evidence of fistulous tract communication.
Left perianal trans-sphincteric sinus tract.