Clinical photograph of the perianal region demonstrating the management of a fistula-in-ano with a loose seton. The image shows a flexible, yellow vascular sling or vessel loop inserted through an external fistula opening located lateral to the anus and exiting through an internal opening within the anal canal. The two ends of the yellow tubing are secured together externally using black non-absorbable sutures to create a continuous, non-constricting loop (loose seton). The surrounding perianal skin shows mild erythema and minor blood spotting consistent with a recent surgical procedure. This clinical finding is characteristic of the surgical treatment for complex or high anal fistulas, where a seton is utilized to promote drainage, prevent recurrent abscess formation, and facilitate the gradual fibrous maturation of the fistula tract while minimizing the risk of fecal incontinence.

A series of four clinical photographs (A–D) illustrating a sphincter-sparing surgical technique for treating fistula-in-ano (FIA) in a pediatric patient. Panel A: Initial clinical presentation of a perianal abscess and fistula opening at the 10 o’clock position, with a previously placed blue silicone seton already visible at the 3 o’clock position. Panel B: Identification and exploration of the fistulous tract using a metal bulb-headed lacrimal probe while a surgical retractor provides exposure of the anal verge. Panel C: Placement of a new silicone vessel loop (seton) by attaching it to the tip of the lacrimal probe to be pulled through the tract. Panel D: Post-procedural view showing the silicone vessel loop ligated loosely outside the anus. This procedure demonstrates a non-cutting seton placement aimed at promoting drainage and controlled fibrosis while avoiding damage to the anal sphincter, particularly relevant in neonatal and infant proctology.

This clinical photograph shows a close-up view of the perianal region in a patient with significant local hirsutism. The primary finding is a small, erythematous skin lesion located approximately 2 cm from the anal margin. The lesion presents as a raised, inflammatory papule or nodule with a central punctum or orifice, suggestive of an external opening for a fistula (fistula in ano). The surrounding skin exhibits a reddish-purple hue and a moist texture, indicating active inflammation and potential purulent discharge. The anatomical context involves the anal sphincter complex and perianal soft tissues. In the provided clinical case, this represents a manifestations of extra-pulmonary tuberculosis (tuberculous anal fistula). Key educational concepts illustrated include the visual presentation of perianal abscess/fistula disease, the identification of inflammatory skin orifices in proctology, and the clinical signs of chronic localized infections.

This clinical photograph shows the perianal region of a patient 8 weeks following a surgical procedure for a complex anal fistula. The image demonstrates the anal orifice and the surrounding skin. Notable features include a prominent area of pale, hypertrophic scarring and fibrotic tissue extending from the right perianal side towards the gluteal fold, indicative of a healing surgical tract or previously active fistula site. There is mild residual erythema and skin irritation immediately surrounding the anus, though the tissue appears largely stable with no visible active purulent discharge or acute abscess formation at this stage. The surrounding skin shows signs of re-epithelialization and maturation of granulation tissue. This image serves as a clinical example of the mid-term healing phase after fistula-in-ano treatment, illustrating the progression of secondary intention healing and scar remodeling in the colorectal/proctological specialty.