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He initially presented with a trans-sphincteric abscess which was drained in theatre multiple times with progressive sepsis and localised necrosis. Patient's co-morbidities included poorly controlled diabetes mellitus whilst on insulin and oral hypoglycaemic agentsischaemic heart disease with percutaneous coronary stent placement within last 2 years and a recent femoral endarterectomy and aorto femoral bypass. Examination reveals a tender, oedematous, haemorrhoidal mass protruding from the anus Fig. They can also cause systemic infection if left untreated. If inflamation p ri anal of these particular types of abscess spreads partially circumferentially around the anus or the rectum, it is termed a horseshoe abscess. Fistulae result from a peri-anal abscess forming a granulation-lined tract between the anal canal inflamation p ri anal the peri-anal skin. StatPearls [Internet].
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