Complex perirectal abscess of urethral origin.

Area of Science:

• Urology
• Colorectal Surgery
• Infectious Disease

Background:

• A 50-year-old male with Lynch syndrome and a history of bladder cancer underwent transurethral resection (TUR).
• He presented with symptoms of perianal pain, rectal tenesmus, and fever, indicating a severe pelvic infection.

Observation:

• Physical examination revealed perianal edema and a palpable rectal orifice.
• CT scans identified a rectal wall defect with extensive bilateral perirectal abscesses.
• Further imaging confirmed a bulbomembranous urethral fistula communicating with the abscesses.

Findings:

• Urgent transanal debridement and drainage of the abscesses were performed.
• Despite initial treatment, the patient's condition remained unstable, prompting a review of his history.
• A diagnosis of a urethral fistula secondary to prior TUR and BCG therapy was confirmed.

Implications:

• The case highlights a rare complication of urological procedures, emphasizing the importance of thorough diagnostic workups.
• Successful management involved a multi-stage approach including abscess drainage, fistula closure via catheterization, and eventual intestinal reconstruction.
• This case underscores the need for vigilance in patients with complex medical histories presenting with pelvic sepsis.