Ischiorectal abscess as an uncommon presentation of rectal adenocarcinoma: A case report and review of literature

Abstract

Perianal presentations of rectal adenocarcinoma are uncommon. Perianal/ischiorectal conditions which harbour malignancy can occur due to infiltration by rectosigmoid growths, invasion of or implantation in previous fistula tracts, or de-novo. Rarely, an ischiorectal abscess or fistula alone can be the sole presenting symptom of locally advanced rectosigmoid adenocarcinoma. Such an abscess may be inadequately treated and will then fail to heal. We report a patient whose sole symptom was an ischiorectal abscess which had failed to heal. On examination, we diagnosed a rectal growth. Biopsies from the lesion and abscess/fistula tracts showed rectal adenocarcinoma. Computerized tomography confirmed the diagnosis of locally advanced rectal adenocarcinoma with ischiorectal fossa infiltration. A high index of suspicion, thorough examination while draining such abscess, and biopsy of such abscesses or tracts will help in averting mishaps, appropriate diagnosis of cause and prompt planning.

Keywords

• fistula in ano
• malignant fistula
• rectal adenocarcinoma