CHRONIC PELVIC OSTEOMYELITIS ASSOCIATED WITH LATE PERINEAL FISTULA AFTER ABDOMINOPERINEAL AMPUTATION: CASE REPORT

Abstract

This case describes a patient with a history of colorectal cancer, previously treated with neoadjuvant therapy and colectomy. Since the postoperative period, the patient has presented with a persistent perineal fistula, with discharge of a foul-smelling secretion and chronic pain in the region. Physical examination revealed a distal perineal orifice of approximately 2 cm, epithelialized, communicating with the pelvic cavity and draining serous and foul-smelling secretion – a picture compatible with ischemic necrosis associated with radiotherapy. Computed tomography showed signs of osteomyelitis in the coccyx and sacrum, without organized collections. Given the clinical picture, maintenance of the orifice open was indicated, with a proposal for hyperbaric oxygen therapy and the use of hydrophilic dressings with silver or antimicrobials. Following overall clinical improvement, the patient was discharged from the hospital with instructions for outpatient follow-up.