Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to oursurgical department with an extraperitoneal purulent inflammation as a complication followingmultiple drainage proceduresfor aposteriorhorseshoe abscess. Emphasisis given to the anatomical and technicalconsiderationsoferadicationofanorectalsepsisandthemanagementofcomplexfistula-in-anoalongwithaconcisereviewoftheliterature.
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