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Anal necrosis is an extremely rare and uncommon disease. It has a rich collateral blood supply. The most common etiology of anal necrosis in the elderly is ischemic secondary to atherosclerosis but anal necrosis in young with no predisposing factor is infrequent thus impeling the authors to write a report. A young middle aged male presented to our emergency department with pain and foul smelling discharge from the anal canal. There was prior history of anal fistula and a recent treatment with herbal medication. The patient underwent computed tomography and magnetic resonance imaging confirming anal canal necrosis with infection. The patient was in septic shock. Antibiotics and supportive volume resuscitation was carried out for managing sepsis. He also underwent prompt debridement with defunctioning loop colostomy. Early reconstruction of the anal canal spinchters and flap construction of the skin and subcutaneous tissue was done to prevent loss of anal canal spinchters control and further morbidity.

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