Extrapulmonary tuberculosis is very rare, representing around 15% of all tuberculosis (TB) cases. Intestinal localization of extrapumonary TB occurs in 1% of the cases and is usually associated with HIV infection. The last portion of the ileum and the ileocecal region are most frequently involved, while perianal localization is extremely rare and has clinical and paraclinical aspects similar to Crohn’s disease, thus leading to difficulties in establishing the diagnosis. We present the case of a 41-year-old patient who came to the proctology department with perianal pain and purulent discharge. He was diagnosed by clinical examination and colonoscopy with multiple simple and complex perianal fistulas complicated with a supralevator abscess. Multiple biopsies were taken and the result was necrotizing granulomatous inflammation. The Ziehl-Neelsen test confirmed the suspicion of perianal TB.

Spontaneous perforation of a gastric ulcer is a rare entity and can often be overlooked considering the frequently silent clinical picture. The posterior erosion of the ulcer through the omental bursa in the retroperitoneal space determines local inflammation which, together with the fibrosis of the retroperitoneal tissue facilitates the enclosure of the gastric content. We present the case of a 49-year old patient investigated for pain in the upper abdomen. The endoscopy performed one month before the admission described a retractile area with a central ulcer on the posterior surface of the stomach, adjacent to the lesser curvature. Given the fact that the abdominal x-ray was normal, a CT scan was performed and a voluminous retroperitoneal cystic lesion was discovered. Combining all the preoperative information the diagnosis was of retroperitoneal abscess by posterior perforation of a gastric ulcer. Surgical intervention was performed, the abscess was evacuated and its wall was completely resected; because of local conditions a distal hemigastrectomy with Roux en Y gastro-enteroanastomosis was chosen over gastrorhaphy and omentoplasty.

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological

Bevacizumab is a monoclonal antibody which has shown promising results in the treatment of varied malignant pathology, including metastasized colorectal cancer. It acts by inhibiting VEGF (vascular endothelial growth factor), and one of its most cited complications is intestinal perforation, by mechanisms which are not yet fully understood. We present the case of a 68 year old patient, operated for metastasized colorectal cancer, which underwent chemotherapy with Bevacizumab, and shortly after initiating therapy developed fistula of low colorectal anastomosis, followed by ischemic perforation of the small intestine.

Anorectal adenocarcinoma is a very rare complication which can occur during the long-lasting evolution of perianal fistulas (PAF), chronic inflammation being the main predisposing factor incriminated for malignant evolution. Moreover, in rare cases (only 28 being published until now), adenocarcinoma developing at the level of a perianal fistula may occur by migration of tumoral cells originating from a rectal cancer into the granulation tissue of the fistula. We present the case of a patient with a rectal adenocarcinoma that has metastasized to a perianal fistula, in evolution for 7 years. Clinical suspicion of malignant seeding at the site of the fistula has been confirmed by immunohistochemical studies.

Perianal endometriosis is a rare pathology which occurs mainly in patients with history of vaginal birth associated with an episiotomy scar. We present the case of a 42 year old patient with history of multiple interventions for right perianal fistula, accusing pain, purulent secretions and bleeding at the site of the interventions. Biopsies collected were specific for endometriosis. In the context of the sphincter involvement, which brings a high risk of incontinence, and the hormone-dependent evolution of this pathology, which tends to regress once menopause is reached, a fistulotomy was made, with subsequent remission of the purulent secretions, but with the persistence of the bleeding from the region during the menstrual cycle.