This case highlights the strengths and weaknesses of different modalities in the assessment of pelvic anastomotic leaks. The leak is clearly delineated on CT and water-soluble contrast enema. On the second CT, no residual collection is visible but the subsequent MRI shows there is a small contained cavity, due to the superior soft tissue resolution of MRI. The final MRI, acquired using an MRI enema protocol, shows the value of using this modality to determine the current status of pelvic inflammation, as well as assess the integrity of the anastomosis, with no radiation imparted.