Intersphincteric abscess: The presence of a tract from 2 o'clock to 6 o'clock about 5 cm away from the anal orifice on MRI, with no external opening, suggests an intersphincteric abscess. This condition involves a collection of pus between the internal and external anal sphincters, which can cause chronic anal discharge.

Ischiorectal fistula: Although less likely given the absence of an external opening, an ischiorectal fistula could still be considered, especially if the tract extends into the ischiorectal fossa. However, the primary description points more towards an intersphincteric location.
Levator ani abscess: This could be a possibility if the infection has spread to involve the levator ani muscle, but it's less common and typically presents with more severe symptoms, including significant pain and possibly a palpable mass.

Perineal abscess: Although the description suggests the abscess is higher and more related to the anal sphincters, a perineal abscess could potentially cause similar symptoms if it's located close to the anal orifice. Missing this diagnosis could lead to significant morbidity due to delayed treatment.
Prolapsed piles (hemorrhoids): While prolapsed hemorrhoids can cause discomfort and discharge, they are less likely to be associated with a distinct tract on MRI. However, they should be considered in the differential to avoid missing a simpler diagnosis that could mimic more severe conditions.

Hidradenitis suppurativa: This chronic skin condition can cause abscesses and fistulas in the perineal area, but it typically involves the skin and subcutaneous tissue more directly and is associated with other characteristic skin lesions.
Crohn's disease: While Crohn's disease can cause perianal fistulas and abscesses, the presentation would typically be part of a broader spectrum of gastrointestinal symptoms, and the diagnosis would require further investigation beyond the local findings.