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Abstract Anal fistula, is presented in its simplest form as a single track with an external opening in the skin of the perianal region, and ano internal opening in the modified skin or mucosa of the anal canal or rectum (D’Hoore and Penninckx, 2001). Most perianal fistulas caused by inflammation of an anal gland. This abscess represents the acute stage of the disease, whereas chronic stage is developed when fistula in and has been established (Strittmatter, 2004). Accurate assessment of the complete fistulous complex involves the localization of all internal and external openings as well as identification of the course of the main tract and its extensions and the anatomy of the fistula in complicated cases should be imaged in a way that is directly related to surgical planes and exploration (Kumar and Scholefield, 2000). Radiological imaging of the pelvis adds an important dimension to our understanding of rectal and perianal disease (Herbst, 2003). Ultrasound has a particular role in recurrent and complex anal fistula and perianal sepsis. Preoperative and perioperative planning with accurate delineation of fistula tracts, extensions and sphincter involvement might help prevent recurrence and impaired continence from sphincter damage after surgery (Rieger et al., 2004). |