Malignant enterocutaneous fistula complicated by pneumorrhachis

A 66-year-old white man presented with perineal pain and fevers. Two-and-a-half years earlier, he had undergone neoadjuvant chemoradiotherapy and an abdominoperineal resection for a T3N0 rectal adenocarcinoma. He had remained in complete remission until 2 months before admission, when he was diagnosed with a local recurrence after magnetic resonance imaging demonstrated a presacral mass. No distant metastatic disease was identified on staging computed tomography, and he subsequently underwent further chemoradiotherapy. Three weeks after completing the treatment, he was admitted to a hospital and noted to