Transperineal ultrasound (TPUS) is employed to assess the rectum and perianal area. This technique is characterized by its simplicity and non-invasiveness. It is well-tolerated, universally accepted, including pediatric and neonatal patients, and low-cost examination. TPUS being a dynamic examination, it allows obtaining a multiplanar reconstruction of anorectal structures. Moreover, as a real-time method, it might be particularly useful in patients where endoanal ultrasound (EUS) and magnetic resonance imaging (MRI) are contraindicated or unavailable, and during follow-up visit for the evaluation and monitoring of perianal disease. Due to the capability to integrate color Doppler and intravenous contrast-enhanced ultrasound (CEUS), it is possible to differentiate between phlegmons and abscesses [1].