Perianal abscess refers to a formed infective-inflammatory collection within the perianal region. It forms part of the broader group of anorectal abscesses. No seguimento, a incidência de formação de fístula nos pacientes com abscesso perianal após a incisão e drenagem foi de 31/68 (45,58%). Perianal and perirectal abscesses are common anorectal problems. The infection originates most often from an obstructed anal crypt gland.

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Secondary Iatrogenic hemorrhoideal surgery Inflammatory bowel diseases Crohn’s disease more common than colitis ulcerosa Infections viral, fungal or TB Malignancy. In these cases the connection with the original fistula tract to the bowel is lost.

While some abscesses may resolve spontaneously via internal drainage into the anal canal, others may require surgical incision and drainage. Pathology Infection and anal gland drainage obstruction from the perianal fistula may lead to an acute perianal abscess. Any localizer that properly displays the anal canal can be used.

Case 9 Case 9. This patient was already known to have an intersfincteric fistula, the mucosal defect is at 1 o’clock.

Continue with coronal images. There is no relation with the sphincter complex.

The Radiology Assistant : Rectum – Perianal Fistulas

Case 8 Case 8. Seton fistulotomy is a technique where a rubber ligature or vessel loop is pulled through the fistula, it then is tightened every 2 weeks or so in order to obtain pressure necrosis so that the Seton is slowly pulled through the muscle.


Position of the mucosal opening on axial images using the anal clock. There is no connection with the external sphincter. It relaxes during defecation. Case 3 Case 3. Case 7 Case 7. Two tracts in the left buttock form a single tract no.

MR imaging classification of perianal fistulas periaanl its implications for patient management. On the left an example of a suprasphincteric fistula. In the intersphincteric space it divides again into two tracts no. If there is an extrasphincteric fistula, the lower part is opened.

Perianal abscess | Radiology Reference Article |

Continue with the coronal images. About Blog Go ad-free. This is the Seton which was inserted to treat the fistula. Perianzl to process the form. There is a small abscess just above the nates.

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Classification The most widely used classification is the Parks Classification which distinguishes four kinds of fistula: Extrasphincteric fistula On the left coronal T2W-images of a small abscess in the pdrianal ischioanal fossa, the fistula runs through the levator ani.

The treatment given depends on the anatomy of the fistula, if it is a simple fistula with a low mucosal defect is can be probed in the OR to identify the mucosal defect at the linea dentata, then abscessl tract can be opened. Axial fatsat images depict the transmural inflammation with infiltration of the mesenteric fat.


A superficial fistula is a fistula that has no relation to the sphincter or the perianal glands and is not part of the Parks classification. On the left coronal T2W-images of a small abscess in the left ischioanal fossa, the fistula runs through the levator ani.

The anorectal ring lies approximately ,5 cm above the linea dentata. On the coronal image the fistula runs caudally towards the skin. Case 4 Case 4. This fistula breaks through the external sphincter no.

The causes of perianal fistulas: Protocol A localizer in three directions is needed in order to align the T2 sequences axial and coronal to the anal canal. Case 6 Case 6. Treatment is focussed on the elimination of the primary and secondary tracts, prevention of recurrence and to retain continence. The drawing on the left illustrates the anal clock, which perianzl the surgeon’s view of the perianal region when the patient is in the supine lithotomy position 2. Perixnal the left perisnal T2W-fatsat images of a transsphincteric fistula with the mucosal opening at 11 o’clock.

The puborectal muscle has its origin on both sides of the pubic symphysis, forming a ‘sling’ around the anorectum. Loading Stack – 0 images remaining. One ends blindly in the intersphincteric space no.