We report two cases of rectal carcinoma presented with perianal abscess. Although perianal abscess is not uncommon, rectal carcinoma is rarely associated with the disease in a frequency of about 1%. In our series of 144 cases of lower rectal carcinoma, two (1.4%) cases were presented with perianal abscess. It has been reported that rectal cancer with perianal abscess has a high risk of local recurrence after curative operation, but in these cases there have been no signs of recurrence.
In both cases, we performed abscess drainage and lavage to control local inflammation prior to curative operation. Abdominosacral excision of the rectum was carried out and the tumor was resected with abscess cavity and abscess wall to prevent local recurrence. In one case, musculocutaneous flap reconstruction was performed secondarily to fill up the dead space in the pelvic cavity and gluteal region. One patient died of pulmonary metastasis two year and three months after the operation, but there was no sign of local recurrence. Other patient has been free from recurrence as of three year and 10 months after the operation.