This chapter discusses the case of a 30-year-old self-employed man who presented to the emergency service with a 1-week history of left ischiorectal abscess. The patient was handed to the colorectal service. Progressive sepsis ensued with a large cavity evident extending out to the left hip joint. Ideally, such a patient with complex anorectal sepsis should be managed by a specialist colorectal surgeon from the outset. This was an unusual set of circumstances and presented particular difficulty in view of the Hirschsprung's surgery. A MRI showed persistence of the fistula track but with more fibrosis than active inflammation. Examination under anaesthesia (EUA) was undertaken with a view to reversing the ileostomy if healing was considered complete. Defunctioning stomas may be required to allow adequate control of sepsis. Long-term setons are often to be preferred for the recalcitrant fistula.