Asian Journal of Research in Surgery

Background: Rectal and anorectal injury is an uncommon but well-recognised complication of radical perineal prostatectomy (RPP), occurring far more frequently after the perineal approach than after the retropubic or robot-assisted routes. When unrecognised or inadequately managed at the time of the index surgery, such an injury can evolve into a chronic anocutaneous or rectourethral fistula, a complication associated with significant morbidity and a difficult, often staged, surgical course.

Case Presentation: We report the case of a man who underwent radical perineal prostatectomy at an outside hospital for Gleason Grade Group 1 (3+3) acinar adenocarcinoma of the prostate (pT2NxMx) and presented to our hospital 15–17 days later with purulent and faeculent discharge from the perineal wound. Digital rectal examination and wound inspection revealed dehiscence of the right lateral suture line with contamination suspicious for a fistulous communication with the anorectum. Contrast-enhanced CT with rectal contrast, performed at our hospital, confirmed an anocutaneous fistula, as demonstrated by a contrast leak tracking from the anorectal lumen to the perineal wound. Following wound drainage and culture-directed antibiotics, the patient underwent diagnostic laparoscopy, laparoscopic adhesiolysis, and laparoscopic-assisted diversion loop ileostomy at our hospital.

Conclusion: This case illustrates the recognised association between the perineal approach to radical prostatectomy and anorectal complications and demonstrates a staged, symptom-guided management pathway — wound care and sepsis control followed by faecal diversion — consistent with published algorithms for post-prostatectomy rectourinary and anocutaneous fistulas.