Perineal Necrotising Fasciitis

We present a case of a 48-year-old lady with a history of bony metastatic breast carcinoma who presented with abdominal pain, diarrhoea and bleeding per rectum. She had recently finished a course of chemotherapy 2 weeks ago. On examination, she was febrile with a temperature of 38.4°C. Her blood pressure was 84/54mmHg and pulse rate was 130/min. She had lower abdominal tenderness with bowel sounds present and a small perineal haematoma. Per rectal examination revealed a small amount of fresh blood, but no surrounding crepitus or induration. Rectoscopic examination was not performed. Fig 1: CT scan of abdomen and pelvis showing free air around rectum Initial haematological investigations revealed a haemoglobin of 11g/dl, white cell count 0.3x10