A retrospective review of 27 patients undergoing anal fistulography is presented. The etiology of the 27 fistulas studied are as follows: cryptoglandular infection in 18, IBD in 7 (Crohn's 6, CUC 1), iatrogenic in 1, and foreign body perforation in 1. Twenty-six fistulograms revealed either direct communication with the anus or rectum, or abscess cavities/tracts, or both. Two fistulograms revealed no radiographic evidence of fistula (one patient had two fistulograms). In 13 of the 27 patients (48 percent) information obtained from the fistulograms revealed either unexpected pathology (n = 7) or directly altered surgical management (n = 6). We conclude that anal fistulography in properly selected patients may add useful information for the definitive management of fistula-in-ano.