Grade IV trans-sphincteric , translevator perianal fistula with internal opening in rectum at 2'o clock position on left side with perianal abscess track extending into gluteal region and showing futher bifurcations and multiple cutaneous openings in left gluteal region as described above. Also horse shoe extension of left perianal abscess is seen with extension of lesion in right interspincteric region. Case submitted by Dr Swati Shah, Dr Ajay Garg, MD Hospital.
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