Presentation
Perianal inflammation.
Patient Data
Left-sided trans-sphincteric active fistulous tract is seen, showing mucosal anal opening at 2 O'clock position, located 1 cm from the anal verge.
Course: Trans-sphincteric to the low ischioanal fat on the left. Cutaneous opening on the left side of the natal cleft. No side branches or abscesses. Intact levator ani, with no supralevator collections identified.
Case Discussion
MRI is the modality of choice to identify the type and course of perianal fistula. It differentiates active from chronic fistula as well as detection and localization of abscesses and side branches. According to St. James university hospital MR classification system, this is grade III left perianal trans-sphincteric fistulous tract.
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