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 result was a basal cell carcinoma; local excision was the only treatment performed for this malignancy.

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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 fi stula, accusing pain, purulent secretions and bleeding at the site of the interventions. Biopsies collected were specifi c 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 fi stulotomy was made, with subsequent remission of the purulent secretions, but with the persistence of the bleeding from the region during the menstrual cycle.

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 fi stula of low colorectal anastomosis, followed by ischemic perforation of the small intestine.