Perianal abscess is a collection of pus that develops in the anal and perianal area due to bacterial inflammation. [1][2] Perianal abscesses are typically caused by an infection in the small glands around the anus. These glands, known as the anal glands or crypts, can become clogged with bacteria and debris, leading to an infection. The most common bacteria that cause perianal abscesses are Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). [1] Certain factors can increase the risk of developing a perianal abscess, such as Crohn's disease, a weakened immune system, anal fissures, sexually transmitted infections like gonorrhea or chlamydia, and conditions that affect the hair follicles in the area, such as hidradenitis suppurativa. [2] The symptoms of a perianal abscess usually start with a small, painful lump or swelling near the anus. As the infection progresses, the lump becomes more painful and may turn red or purple. Other symptoms may include fever, chills, and a general feeling of illness.[1][3] The pain and discomfort can intensify during activities like sitting, walking, or passing stool. If left untreated, the infection can spread to nearby tissues, leading to complications like fistula formation. [3] An anal fistula is an abnormal tunnel that connects the infected gland to the skin around the anus. This cancause ongoing discharge of pus or feces from an additional opening near the anus.[4] Another fatal complication is sepsis, that can occur if the infection of the mucous sacs on the sides of therectum spreads and penetrates into the perineal muscles or the skin, causing a systemic infection [3]. For these reasons prompt medical attention is crucial when dealing with a perianal abscess. The diagnosis of anal abscesses can be made through various imaging techniques, both in emergency andelective settings. Imaging techniques can help in diagnosing perianal abscesses and determining the extentof the infection. According to the World Society of Emergency Surgery (WSES) and the AmericanAssociation for the Surgery of Trauma (AAST), magnetic resonance imaging (MRI) and endoanal ultrasound(EUS) are considered the diagnostic methods of choice for perianal abscesses [5]. Ultrasound can help visualizethe abscess and its characteristics, such as location, size, and presence of any associated complications. It isoften used as the initial imaging modality for perianal abscesses due to its availability, cost-effectiveness,and lack of radiation. [6] MRI is especially helpful for evaluating the soft tissues and can provide excellentvisualization of perianal abscesses, their relationship to adjacent structures, and identification of fistulas orother associated pathologies. MRI is often the preferred imaging modality for complex or recurrent cases. [5][6] Another imaging technique in the perianal abscesses diagnosing is fistulography. [7] Fistulography involvesinjecting a contrast agent into the fistula tract to outline its course and extent. This procedure can helpidentify the anatomical characteristics of a fistula associated with the abscess and aid in treatmentplanning.[7] The choice of the imaging modality depends on various factors, including the patient's clinical presentation, severity of symptoms, suspected complications, and availability of resources. The specific imaging technique chosen may also vary among different healthcare settings, such as emergency departments or elective outpatient clinics. In emergency situations, the use of MRI and EUS is limited due to their respective challenges. MRI typically requires long acquisition times, which can be impractical when immediate diagnosis and intervention arerequired. On the other hand, EUS is often precluded in emergency situations due to intense anal pain experienced by awake patients. Both MRI and EUS have their unique benefits and applications in different medical scenarios.[6] However, in emergency situations where prompt decision-making and swift action are crucial, alternative diagnostic methods are typically employed. These alternative methods include CT scan that represents a more accessible imaging technique that can provide quicker results with minimal discomfort for the patient. [8] In an emergency approach, the primary goal is to confirm the presence of the abscess and determine ifimmediate drainage is required.[9] CT can be used as the first diagnostic tool to evaluate the extent of infection and identify any complications. CT allows for detailed visualization of the anatomy in the anal and rectal region, revealing any areas of inflammation, abscesses, or fistulas that may be contributing to the sepsis. It can also detect any involvement of surrounding tissues, such as muscles and blood vessels, which may beaffected by the spread of infection. [8] Once a diagnosis of anal rectal sepsis is confirmed through CT, appropriate treatment can be planned. This may include surgical intervention to drain abscesses, the use of targeted antibiotics against the infectious agent, or other specific treatments. [9]