**4.6 Supralevator extension**

In rare cases, intersphincteric sepsis tracks cranially, reaching the supralevator space via intersphincteric plane, limited only by the fascia of levator ani (extension of pelvic fascia) [2, 5]. It is unlikely that these collections spread across the levator ani. However, it is possible for the collection to enter the deep postanal space (posteriorly) or infra-levator space via a high transphincteric path or a suprasphincteric path as described above, forming an infra-levator abscess. These 2 are difficult to differentiate clinically, and erroneous drainage of these abscesses may lead to more complex iatrogenic fistulas such as extra-sphincteric fistula or a translevator fistula. Therefore, MRI imaging is advocated if such pattern is suspected [14, 15].
