Ischiorectal abscess with fistulization into the thigh, the 'perfect storm' patient.

Ischiorectal abscesses are a common encounter, both for general surgeons and for colorectal specialists. The formation of an ischiorectal fistula into the posterior thigh is an atypical extension that is rarely reported. In this case, the patient's HIV history and prior chemoradiation for anal squamous cell carcinoma contributed to this unique presentation. This case highlights the importance of heightened clinical suspicion, thorough imaging, and individualized operative management in high-risk patients presenting with a seemingly straight-forward pathology.