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Unusual presentation of anorectal carcinoma

SIR,-We read with interest the unusual presentation of anorectal carcinoma reported by Mr J Drumm and others (13 November, p 1393) and were surprised at the suggestion that the association between ischiorectal abscess and underlying carcinoma of the rectum had not been previously reported. The association of the rare pelvirectal type of abscess with rectal carcinoma is referred to in standard surgical texts such as that by Goligher,' and rectal cancer was found in two of 183 patients with anorectal abscesses other than those of the pelvirectal type in the report by Buchan and Grace.2 In addition, McConnell3 has reported the association of perianal abscess with squamous cell carcinoma of the anus. We would certainly agree, however, that thorough examination of the rectum at the time of incision of an anorectal abscess is important not merely to seek malignant disease but also to find evidence of any other aetiological factor-for example, inflammatory bowel disease. To emphasise these points we report the case of a 45 year old man who presented in 1981 with an ischiorectal abscess. The abscess was incised and drained, and because of the extent and severity of the perianal sepsis and suspicions about irregularity of the rectal mucosa a sigmoid colostomy was performed. Biopsy specimens confirmed the presence of a low rectal carcinoma, and subsequent abdominoperineal resection was undertaken. The patient has returned to work and has remained clinically free from recurrent disease for 15 months.