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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.<\/jats:p>","DOI":"10.1093\/jscr\/rjae801","type":"journal-article","created":{"date-parts":[[2024,12,22]],"date-time":"2024-12-22T16:09:41Z","timestamp":1734883781000},"source":"Crossref","is-referenced-by-count":0,"title":["Complex perianal abscess: a case report of shooting from the hip"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9840-602X","authenticated-orcid":false,"given":"Peter","family":"Tilleard","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cairns Hospital , 165 The Esplanade, Cairns 4870 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Swift","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cairns Hospital , 165 The Esplanade, Cairns 4870 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pelvic sepsis and colostomy: the importance of infection control","volume":"2","author":"Asensio-G\u00f3mez","year":"2017","journal-title":"Surg Infect Case Rep"},{"key":"2024122216092969100_ref11","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/01.sla.0000161030.25860.c1","article-title":"Perianal Crohn disease: predictors of need for permanent diversion","volume":"241","author":"Galandiuk","year":"2005","journal-title":"Ann Surg"},{"key":"2024122216092969100_ref12","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jpedsurg.2012.05.034","article-title":"Early diverting colostomy for perianal sepsis in children with acute leukemia","volume":"47","author":"Pini Prato","year":"2012","journal-title":"J Pediatr Surg"},{"key":"2024122216092969100_ref13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/MPH.0000000000000324","article-title":"Colostomy for perianal sepsis with ecthyma gangrenosum in immunocompromised 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