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Chronic fistulas are a dreaded complication to surgery. They are often persistent to treatment and involve several negative side effects and a significant reduction in quality of life. We present a case report of a 36-year-old male with a deep chronic fistula in the pelvis after pouch surgery. More than 60 procedures were performed under general anaesthesia without treatment effect. Through a multidisciplinary approach a complete rectum extirpation and reconstruction with a free latissimus dorsi flap was performed. The patient was seen at followup 18 months after the surgery; pain free and without relapse.