A young woman with recurrent perianal sepsis

摘要: A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, she started on oral topical mesalazine. In the following months admitted twice with acute perianal sepsis, required examinations under anaesthesia drainage an intersphincteric abscess. She later presented after feeling generally unwell days “flu-like” symptoms pain. On examination tenderness fluctuance in region right ischial tuberosity, external fistula opening visibly perineum. Her tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only. ### 1. What imaging modality should used investigate this clinical presentation? #### Answer Magnetic resonance (MRI) pelvis. #### Discussion Although a variety techniques can image fistulas, MRI is widely accepted as technique choice patients who present recurrent sepsis or signs complex fistulation those Crohn’s disease. Perianal fistulography, catheterised water soluble contrast agent injected, now rarely used. This because both primary tract extensions may fail fill sphincter muscles are not directly visualised, hinders anatomical assessment. The test less accurate reliable than modern techniques.1 2 Computed tomography depict fistulas associated abscesses …