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A 64-year-old female came to our hospital presented with diffuse abdominal dull pain, distension and constipation for three days. She denied vomiting, diarrhea, fever, body weight loss or change of bowel habit. Distended  abdomen and diffuse tenderness without peritoneal sign  were found by physical examination. There was no leukocytosis or electrolyte imbalance. KUB showed focal dilatation of transverse colon. Computed tomography (CT) revealed irregular luminal narrowing at distal transverse colon with perifocal fat stranding (Figure 1), suggestive of malignancy change. 

Despite proper treatment and apparent healing after surgery, a recurrent ano-perianal abscess may develop in up to 10% of patients, especially if the opening on the skin heals. Factors reported to be associated with recurrence include complex type of fistula, horseshoe extension, lack of identification or lateral location of the internal opening, previous fistula surgery, and the surgeon performing the procedure. Findings on pelvic MRI have been shown to have accuracy up to 90% for mapping the fistula tracts and 80-90% concordance with operative findings. We report the unusual case of an unknown persistent deep perirectal abscess occurring in an asymptomatic man two years after surgery. PDFLINK