High intersphincteric anal fistulas are rare, particularly in women. Due to their low incidence, diagnosis and treatment are not strictly standardized; therefore, each case requires an individual assessment of the anatomical features and clinical presentation. This article presents a clinical case of a 44-year-old woman with a high intersphincteric internal–internal anal fistula with two internal openings. The patient had a history of a perianal abscess, and magnetic resonance imaging (MRI) revealed a T-shaped fistula with complex anatomy and no clearly identifiable external opening. MRI was essential for assessing the course of the fistula, its branches, and its relationship to the surrounding anatomical structures. Given the anatomy of the fistula, a staged treatment approach was chosen: a draining seton was inserted during the first stage, followed by fistulotomy after repeated evaluation. This clinical case highlights the importance of MRI in the diagnosis and treatment planning of complex anorectal fistulas and suggests that staged treatment may be a safe and effective sphincter–preserving approach.
1. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 2011; 54(12): 1465–1474. DOI: 10.1097/DCR.0b013e31823122b3.
2. Yamana T. Japanese practice guidelines for anal disorders II. Anal fistula. J Anus Rectum Colon 2018; 2(3): 103–109. DOI: 10.23922/jarc.2018-009.
3. Almughamsi AM, Elhassan YH. Understanding the anatomical basis of anorectal fistulas and their surgical management: Exploring different types for enhanced precision and safety. Surg Today 2025; 55(4): 457–474. DOI: 10.1007/s00595-025-02995-2.
4. Bubbers EJ, Cologne KG. Management of complex anal fistulas. Clin Colon Rectal Surg 2016; 29(1): 43–49. DOI: 10.1055/s-0035-1570392.
5. Jimenez M, Mandava N. Anorectal fistula. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2026. Available from: <http://www.ncbi.nlm.nih.gov/books/NBK560657/>.
6. Reza L, Gottgens K, Kleijnen J, Breukink S, Ambe PC, Aigner F, Aytac E, Bislenghi G, Nordholm-Carstensen A, Elfeki H, Gallo G, Grossi U, Gulcu B, Iqbal N, Jimenez-Rodriguez R, Leventoglu S, Lisi G, Litta F, Lung P, Millan M, Ozturk E, Sackitey C, Shalaby M, Stijns J, Tozer P, Zimmerman D. European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula. Colorectal Dis 2024; 26(1): 145–196. DOI: 10.1111/codi.16741.
7. Schrader L, Brandstrup B, Olaison G. Slowly cutting, loose seton ligature and staged fistulotomy for healing of idiopathic perianal fistula and influence on anal continence. Langenbecks Arch Surg 2023; 408(1): 352. DOI: 10.1007/s00423-023-03005-0.
Šis darbas apsaugotas Creative Commons priskyrimo 4.0 viešąja licencija.