Complex Perianal Fistula

A 60-year-old male with a history of a drained abscess in the right leg consulted for suprapubic and perineal suppuration that had been progressing for over several months. Examination revealed a complex transsphincteric perianal fistula with right and left external openings. Fistulography (Figs. 1 and 2) with contrast material introduced through the abdominal orifice showed evidence of a cavity on the left side of the pelvis measuring 5 × 2 cm with several fistulous tracts towards the perineum that connected with the anus, and another descending towards the root of the right thigh. Surgical treatment included opening the postanal space, ischiorectal drainage and seton placement. The postoperative evolution was favorable with flushing through the external fistulous orifices.

Figure 1

Figure 2

Acknowledgements

Thanks to my fellow surgeons and the General Radiology Department at the Complejo Asistencial Universitario in León, Spain.