Fig. 5

A 50-year-old male patient presented with discharging fistulous openings. MRI examination in the form of multiple pulse sequences after local injection of saline and gel revealed in axial T2 images (A–E): A External cutaneous opening of the fistulous tract at the right perianal region (white arrow). B Fistulous tract at the intersphincteric space (red arrow) with another posterior midline fistulous tract (arrowhead). C Internal mucosal opening at 11 o’clock (yellow arrow). The posterior midline tract was seen in the intersphincteric space (dashed arrow). D The internal mucosal opening of the posterior midline tract was located in the anal canal at six o’clock (green arrow). E Extended branches on both sides of the anal canal giving a horseshoe appearance (blue arrow). The final diagnosis was a right, grade II, intersphincteric fistula