PMC8107657_01
(a) Photograph of the perineum with the patient positioned in lithotomy. Clean based ulceration in the natal cleft without any evidence of underlying fluctuance to suggest a pilonidal abscess (arrow). Note the adjacent seton facilitating drainage of a previous perianal fistula. Note also a keloid scar formed from a previous ulcer site at the 3 o'clock position - there is a propensity for ulcers to leave residual scars in Behcet's syndrome. (b) A 3 x 2 mm ulcer near the junction of the right hemiscrotum and medial thigh, again with no evidence of underlying fluctuance. (c) Ulceration with adjacent induration at the lateral end of the proximal shaft of the penis.
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On examination, there were multiple clean based ulcerations ranging from 2 to 5 mm in the perineum (Figure 1).
T2-weighted fat-suppressed MRI sequence in the coronal plane demonstrating a fistulous tract between openings in the left groin and the perineum (arrows). The perineal end of the tract demonstrates a component extending medially towards the rectum.
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T2-weighted imaging, there was evidence of a tract adjoining the left groin to the perineum, along with a medial branch extending towards the rectum (Figure 2). The tract was drained via the perineal opening and a seton inserted to allow drainage and healing of the complex fistula.