直肠癌常见的症状如便血、挛缩性便秘、直肠疼痛和排便习惯改变是众所周知的，但也可能是非特异性的和误诊的。罕见的表现与这些传统症状结合出现时，需要更高度的临床怀疑。在这里，我们报道了一例表现为周围直肠脓肿的直肠腺癌病例。一名患有失控的糖尿病的52岁男性患者出现了2年2个月的直肠出血和排便习惯改变症状，这被归因于其他病情。他最初出现左臀部疼痛和严重败血症。由于怀疑为福尼耶溃疡和周围直肠脓肿，接下来的检查发现了直肠腺癌（T4N0M0，IIB/C期）。切除坏死组织、使用抗生素治疗、新辅助化疗放疗和下腹会阴联合切除手术后，患者的病情得到了改善和缓解。总之，直肠癌的罕见表现，如周围直肠脓肿，尤其是与传统的直肠癌症状一同出现时，可能需要对直肠癌进行进一步检查。

Classic symptoms of rectal cancer (RC) such as hematochezia, tenesmus, rectal pain, and bowel habit changes are well known but can be nonspecific and misdiagnosed. Rare presentations, in combination with these conventional symptoms, can occur warranting a higher degree of clinical suspicion. Here, we report a case of rectal adenocarcinoma presenting as a perirectal abscess. A 52-year-old male with uncontrolled diabetes mellitus presented with a 2-year and 2-month history of rectal bleeding and changes in bowel habits, respectively, which were attributed to other conditions. He initially presented with left buttock pain and severe sepsis. Subsequent workup for suspected Fournier's gangrene and perirectal abscess led to the discovery of a rectal adenocarcinoma (pT4N0M0, stage IIB/C). A combination of debridement, antibiotic therapy, neoadjuvant chemoradiation, and abdominoperineal resection resulted in improvement of the patient's condition and remission. In conclusion, rare presentations of RC, such as a perirectal abscess, especially if present in conjunction with conventional RC symptomology, may necessitate the workup of RC.© 2023 The Author(s). Published by S. Karger AG, Basel.