Rectogluteal fistula presenting as necrotising myofasciitis of the gluteal region

Rectogluteal fistulae are rare complications of pelvic malignancy and irradiation that have been poorly documented in medical literature. Risk factors for enterocutaneous fistulae to the lower limb include pelvic radiation, diverticulitis, Crohn’s disease and steroid use. A multidisciplinary approach including infectious diseases physicians, general surgeons, orthopaedic surgeons and specialised nurses is essential to successfully manage such complications.We present the case of a female in her 80s with a rectogluteal fistula affecting her gluteal region as a late complication of pelvic radiation for rectal cancer. The fistula was successfully treated with serial surgical debridements of her gluteal region, a defunctioning loop ileostomy and negative pressure wound therapy. She made a good recovery with no further cellulitic changes or wound dehiscence observed at follow-up.Rectogluteal fistulae are rare and complex conditions requiring multidisciplinary collaboration for patient care. Effective infection control and wound care were the key contributors to achieving a favourable outcome in this patient.