Rectal perforation associated with sunitinib therapy.

In 2008 he was diagnosed with a rectal adenocarcinoma (pT3N0M0) and villous adenoma at 11 and 4 cm from the anal margin, respectively. Short-course radiotherapy (25 Gy in 5 Gy daily fractions) was administered and the patient underwent anterior rectal resection plus perianal adenoma resection. During follow-up a positron emission tomograph was performed (2011), which identified two nodules; one in the left suprarenal area and another in the nephrectomy surgical area, suggesting a locoregional recurrence of the renal carcinoma. In view of this finding treatment is initiated with sunitinib 50 mg/day for 4 weeks, with a two weeks rest between cycles. After 7 cycles of treatment the patient had a complete response as confirmed by an abdominopelvic scan. Seven days after cycle thirteen the patient presents at the ER with pain, an anal growth and fever. A fluctuating abscess with crepitation is felt on palpation in the right gluteus, and digital rectal examination reveals a wide orifice, approximately 1 cm in diameter, at 5-6 cm from the anal margin on the left posterolateral rectal wall. An abdominopelvic scan defines a communication between the rectal lumen and perirectal fat, as well as cellulitis in the gluteus maximus muscle. With a suspicion of rectal perforation associated with necrotizing fasciitis an urgent surgical procedure is decided upon. An incision is performed on the fluctuating area that lets fecaloid contents out. An abscess traject opens on the right posterior wall of the rectum. A counterincision is carried out and a drain is put in place. A histopathologic examination of the orifice and its surroundings reveals inflammatory tissue with no evidence of malignancy.