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Perianal abscess is caused by an infection of anal glands located in between the sphincter muscles of the anal canal. An enterocutaneous fistula is a chronic manifestation of an acute perirectal process that forms an anal abscess. The rate of perianal abscess is increasing annually and the incidence of fistula formation following perianal abscess occur reportedly at a higher rate. Precise diagnosis of a recto-cutaneous fistula is a key factor in its eventual management. Here, the author discusses a diagnostic approach to a rare case of a recto-cutaneous fistula using a magnetic resonance imaging (MRI).