Recurrent vaginal squamous cell carcinoma mimicking peri-rectal abscess: The role of endoscopic ultrasound

Recurrence of vaginal squamous cell carcinoma (SCC) involving the rectum is extremely rare and usually results from direct spread of the primary tumor. Such cases often present with pelvic metastases and can mimic infectious or inflammatory conditions, complicating diagnosis and delaying treatment. While computed tomography scans are commonly used for diagnosis, they may be misleading. Endoscopic ultrasound (EUS) is crucial for accurately assessing rectal and perirectal lesions. We present the case of a 60-year-old female with a history of vaginal SCC who presented with refractory constipation. Initial imaging suggested a perirectal abscess, but a definitive evaluation with EUS revealed rectal wall thickening and a lesion involving the submucosa. Biopsy confirmed high-grade squamous intraepithelial neoplasia consistent with recurrent vaginal SCC. This case highlights the critical role of EUS in diagnosing recurrent pelvic malignancies with rectal involvement.