Phlegmon, Not Abscess: Multimodal Transperineal Ultrasound Altering Surgical Approach in a Case of Complex Perianal Fistulizing Crohn's Disease.

Authors

Partha Pal, Mohammad Abdul Mateen, Mohammad Fazelul Rahaman Shoeb, Chikkam Sandeep, Kamsala Chaitanya, Uday Kumar Marri, Piprikar Rama Rao, Syed Misba Naaz, Rajesh Gupta, Manu Tandan, Pradeep Rebala, D Nageshwar Reddy

Published in

Journal of clinical ultrasound : JCU. Jul 26, 2026. Epub Jul 26, 2026.

Abstract

Complex perianal Crohn's disease often requires functional assessment beyond anatomy. We report a 30-year-old man with transsphincteric fistulae and supralevator extension. Point-of-care transperineal ultrasound with contrast and shear-wave elastography showed avid rim enhancement and mixed stiffness in a left ischioanal lesion, favoring phlegmon over liquefied abscess. Magnetic resonance imaging confirmed complex tracts; endoscopic ultrasound deemed internal drainage unsafe. On examination under anesthesia, a seton was placed, and only a limited incision was performed, yielding minimal pus. Multimodal transperineal ultrasound provided real-time vascular and tissue characterization, altered surgical planning, and avoided unnecessary wide drainage while complementing MRI.

PMID:
42503177
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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