Abstract
The perianal abscess is a common emergency surgical presentation. While in most cases simple drainage suffices, occasionally the abscess can track deeply presenting a management challenge. We describe the case of a complex circumferential horseshoe ischioanal abscess with extension below the levator ani through the greater sciatic notch and into the left gluteal region, with the collection involving the intergluteal space and gluteus maximus. The complex nature of the abscess warranted a novel joint approach by Colorectal surgery and Orthopaedic surgery teams. This case highlights the importance of maintaining a high degree of suspicion for, early recognition and imaging of deeper anorectal abscess extension.