Background: Transrectal ultrasound guided prostate biopsy (TRUS-PB) is a common investigation for assessment of prostatic carcinoma. Loco-regional complications of TRUS-PB are uncommon and usually relate to infective processes from bacteria present in the rectum. We present a novel case of an abscess from a rectal diverticular perforation secondary to TRUS-PB to highlight this complication as a potential concern for this diagnostic modality. Methods: We present a 55-year-old male who underwent TRUS-PB for investigation of elevated prostate-specific antigen (PSA) (PSA 3.5ug/l). Three weeks following this procedure, at the hospital, the patient presented with septic shock requiring inotropic support. Computed tomography (CT) identified a contained rectovesical abscess anterior to the upper rectum. The patient required operative intervention as he failed to improve on conservative management. Histopathological assessment confirmed recent perforation through the anterior rectum via a rectal diverticulum. Results: Post-operatively, the patient recovered rapidly and was discharged day nine. The patient underwent a laparoscopic-assisted reversal of Hartmann's stoma approximately 8 mo after his initial operation.
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