Pelvic Sepsis Secondary to Necrotic Coloanal Anastomosis After Perineal Proctosigmoidectomy Leading to Emergent Abdominoperineal Resection: A Rare Case and Complication

Abdominoperineal resection (APR) is a surgical procedure that involves the complete removal of the anal canal, anal sphincter complex, rectum, and a portion of the sigmoid colon with creation of an end colostomy. This procedure is primarily indicated for patients with low rectal cancers where the anal sphincters cannot be spared and anal cancers refractory to chemoradiation or recurrent anal cancers. It can also be performed in patients with severe perianal Crohn's disease, complex anorectal fistulae, or patients with severe trauma to the anus/rectum where the sphincter complex is significantly affected. This is a complex procedure with a high complication rate, and patients generally undergo extensive perioperative planning and assessment to optimize a positive outcome. In this report, we describe a rare case of emergent APR in a patient who presented with pelvic sepsis secondary to necrotic rectum and colon after a prior emergent Altemeier procedure at another hospital. A thorough literature review has revealed only one prior documented case of emergent APR.