Case Study: Jaspal Singh

Patient Name: Jaspal SIngh

Age: 37/M

There is a fluid-filled, trans-sphincteric fistulous tract, with the cutaneous opening seen in the left lower gluteal region, cranial to the level of the perianal skin/anal verge. The fistulous tract extends first slightly caudally and then slightly cranially, through the left gluteal fat and then pierces the external anal sphincter musculature. The tract terminates dominantly into an intersphincteric abscess measuring approx. 21 (CC) x 20(AP) x 14 ML)mms. The mucosal opening of the tract is difficult to discern and is present either 6 o’clock position approx. 50mms above the anal verge (axial T2 image 13) or at 6 o’clock position approx.. 30mms above the anal verge (axial T2 image 15). The total length of the tract is approx. 85mms. No side branches seen. Mild inflammation seen rounding the tract in the left-gluteal and perianal region. No ischioanal or ischiorectal mucossa collection seen. No supralevator extension seen. Minor inflammation seen in the tuborectalis and the posterior fibres of the levator ani muscle. Urinary bladder is partially distended, wall thickness is grossly normal. No intraluminal fling defect is seen. Prostate is normal. Major flow phenomenon are normal.

IMPRESSION: Trans-sphincteric fistula with the cutaneous opening seen in the left lower gluteal region and terminating predominantly into an intersphincteric abscess in the anal canal, with extent as described.