{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:15Z","timestamp":1756425735811,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,17]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Abdominoperineal excision of rectum (APER) is one of the widely used surgical procedures to treat low rectal cancer, benign conditions like Crohn\u2019s proctitis with anal involvement and as a salvage procedure for anal cancer. Perineal wound infection is a well-recognised complication following such major surgery. Occurrence of appendicitis in a few weeks\u2019 time following such a major surgery is uncommon. However, here we present a rare case report of perforated appendicitis presenting as persistent perineal discharge in an elderly man, following laparoscopic APER for a low rectal tumour. To our knowledge, this is the first time such a rare clinical presentation of appendicitis is reported in the history of medical literature. Through this case report, we aim to highlight the importance of considering such an uncommon presentation in patients with perineal discharge, following APER.<\/jats:p>","DOI":"10.1136\/bcr-2020-236312","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T01:30:16Z","timestamp":1610415016000},"page":"e236312","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rare case of perforated appendicitis presenting as persistent perineal discharge following laparoscopic abdominoperinal excision of rectum (APER)"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5571-5896","authenticated-orcid":false,"given":"Tanmoy","family":"Mukherjee","sequence":"first","affiliation":[{"name":"General Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2637-5970","authenticated-orcid":false,"given":"Shantata Jayant","family":"Kudchadkar","sequence":"additional","affiliation":[{"name":"General Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayesh","family":"Sagar","sequence":"additional","affiliation":[{"name":"General Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shashank","family":"Gurjar","sequence":"additional","affiliation":[{"name":"General Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"2025082722411062000_14.1.e236312.1","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/S0140-6736(00)99076-7","article-title":"A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon","volume":"2","author":"Miles","year":"1908","journal-title":"Lancet"},{"key":"2025082722411062000_14.1.e236312.2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182334121"},{"key":"2025082722411062000_14.1.e236312.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0855-x"},{"key":"2025082722411062000_14.1.e236312.4","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1111\/j.1463-1318.2006.01159.x","article-title":"Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma","volume":"9","author":"Artioukh","year":"2007","journal-title":"Colorect Dis"},{"key":"2025082722411062000_14.1.e236312.5","doi-asserted-by":"crossref","first-page":"076","DOI":"10.1055\/s-2008-1055325","article-title":"Perineal wound complications after abdominoperineal resection","volume":"21","author":"Wiatrek","year":"2008","journal-title":"Clin Colon Rectal Surg"},{"key":"2025082722411062000_14.1.e236312.6","doi-asserted-by":"crossref","DOI":"10.1155\/2010\/126483","article-title":"Laparoscopic repair of postoperative perineal hernia","volume":"2010","author":"Ryan","year":"2010","journal-title":"Case Rep Med"},{"key":"2025082722411062000_14.1.e236312.7","unstructured":"Schwartz SI , Shires GT , Spencer FC . 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