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We report a 68-year-old man with a complex horseshoe perianal abscess that extended into the deep gluteus maximus. Initial drainage targeted the anorectal spaces based on clinical and magnetic resonance imaging findings, yet postoperative fever and persistent pain prompted repeat imaging, which revealed a deep gluteal abscess. Ultrasound-guided catheter drainage was performed successfully without complications. This case illustrates an unusual pathway of infection spread from the anal gland through the intersphincteric space and ischiorectal fossae into the gluteal compartment. Contributing factors included delayed presentation, malnutrition, and immunosuppression. Comprehensive assessment, multidisciplinary management, and image-guided intervention were essential for a successful outcome. Clinicians should suspect deep gluteal extension in patients with persistent systemic signs despite perianal drainage to avoid diagnostic delay and improve outcomes.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf885","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:33:25Z","timestamp":1761046405000},"source":"Crossref","is-referenced-by-count":0,"title":["Horseshoe perianal abscess with deep gluteal extension managed by multi-incision and ultrasound-guided catheter drainage: a case report"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2380-8220","authenticated-orcid":false,"given":"Ruirui","family":"Liu","sequence":"first","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaqin","family":"Li","sequence":"additional","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shenglan","family":"Zhong","sequence":"additional","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Runyi","family":"Geng","sequence":"additional","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Xu","sequence":"additional","affiliation":[{"name":"Anorectal Department, Shanghai Fourth People\u2019s Hospital Affiliated to Tongji University , No. 1279 Sanmen Road, Hongkou District, Shanghai 200434 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"2026032112345666500_ref1","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/DCR.0000000000002473","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula","volume":"65","author":"Gaertner","year":"2022","journal-title":"Dis Colon Rectum"},{"key":"2026032112345666500_ref2","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1186\/s12876-023-02959-1","article-title":"Study on the factors influencing the prognosis after perianal abscess surgery","volume":"23","author":"Dong","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"2026032112345666500_ref3","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1111\/j.1742-1241.2001.tb11015.x","article-title":"Crohn\u2019s disease presenting as left gluteal abscess","volume":"55","author":"Hussien","year":"2001","journal-title":"Int J Clin Pract"},{"key":"2026032112345666500_ref4","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1007\/BF02556793","article-title":"Anorectal sepsis as a presentation of occult rectal and systemic disease","volume":"31","author":"Winslett","year":"1988","journal-title":"Dis Colon Rectum"},{"key":"2026032112345666500_ref5","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1007\/BF02587008","article-title":"A prospective survey of 474 patients with anorectal abscess","volume":"22","author":"Read","year":"1979","journal-title":"Dis Colon Rectum"},{"key":"2026032112345666500_ref6","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1055\/s-0043-1777451","article-title":"Anorectal abscess","volume":"37","author":"Kata","year":"2023","journal-title":"Clin Colon Rectal Surg"},{"key":"2026032112345666500_ref7","doi-asserted-by":"crossref","first-page":"tkaf031","DOI":"10.1093\/burnst\/tkaf031","article-title":"CANF experts group representing the Chinese Burn Association, editorial Board of the Chinese Journal of Burns and Wounds, & burn medicine branch of China International Exchange and Promotion Association for Medical and Healthcare (2025). 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