Recto-Femoral Fistula Presenting as Emphysematous Cellulitis of the Knee: A Case Report & Literature Review

Abstract

Purpose. The rectofemoral fistula represents a devastating complication of colorectal surgery. Its early diagnosis and treatment are critical to obtain a good patient outcome. Case Presentation. A 75-year-old Caucasian female patient presented with high fever, ileus, low back pain, sciatic nerve palsy, and infection of the right knee. After numerous surgical debridements and antibiotic therapies, a rectofemoral fistula was diagnosed. Conclusion. Increased doctors' alertness is mandatory for the early identification and surgical treatment of patients suffering from a rectofemoral fistula before the stage of diffuse infection has significantly decreases their postoperative morbidity and mortality.

Rectogluteal fistula presenting as necrotising myofasciitis of the gluteal region

“…Identification of rectogluteal fistulae to the lower limbs requires a high degree of clinical suspicion. Their presentation is often non-specific with symptoms including hip pain, sciatic nerve palsies, cellulitis or abdominal pain 6 7. In this case, timely identification of subcutaneous emphysema on plain radiographs appropriately prompted a diagnosis of potential necrotising myofasciitis and early intervention with washout and debridement 3 5 7.…”

“…We present the case of a rectogluteal fistula as a late complication of rectal cancer treatment presenting initially as necrotising myofasciitis. Colonic fistulae to the lower limb have been described in a small number of case reports 1–7. These fistulae reportedly arise as complications of diverticulitis, inflammatory bowel disease, total hip arthroplasty or hip arthrodesis 1–7.…”

“…Colonic fistulae to the lower limb have been described in a small number of case reports 1–7. These fistulae reportedly arise as complications of diverticulitis, inflammatory bowel disease, total hip arthroplasty or hip arthrodesis 1–7. Risk factors associated with enterocutaneous fistulation of a native hip include pelvic radiation for malignancy, diverticulitis, Crohn’s disease and steroid use 1.…”

Colorectal anastomotic perforation secondary to acute ruptured appendicitis presenting as septic arthritis

“…Examination intraoperatively suggested that the appendix had become chronically adhesed to the colorectal anastomosis with subsequent development of acute appendicitis with suppurative rupture through the anastomosis. Intestinal perforation diagnosed with presenting complaints of subcutaneous emphysema, [4,5] cellulitis, [6] and enterocutaneous fistula [7] have been reported. This case of a ruptured colorectal anastomosis secondary to acute ruptured appendicitis was uniquely diagnosed as right hip septic arthritis, thereby expanding the differential diagnosis of the presenting complaint.…”

“…Intestinal perforation may present involving lower extremity complaints. [4][5][6][7] We present the case of a 66-year-old male with septic arthritis of the right hip secondary to pathology-proved acute ruptured appendicitis causing colorectal anastomotic perforation and subsequent suppurative fecal necessitation through the pelvis and right lower extremity occurring five years following lower anterior resection (LAR) with adjuvant chemoradiation therapy for stage unspecified colorectal cancer.…”