This is a case, summarised for educational purposes, of a 44-year-old male with metastatic rectal cancer. After a low anterior resection with loop ileostomy, he remained stable for two years until an MRI scan showed local recurrence with posterior rectal wall thickening. He then had a colonoscopy which revealed a malignant ulcerated mass at the anastomotic site. He presented to pain clinic with severe neuropathic perianal pain.
