Rectal abscess may result in necrotizing soft-tissue infection including fasciitis, myositis, and extraperitoneal dissection of pus without muscle necrosis. The presentation and therapy of ten patients treated over the past six years are reviewed. Early recognition of rapidly spreading infection was imperative. The mortality rate of 40 per cent correlated with the degree of sepsis present at admission. The high mortality attendant with the complications of rectal abscess emphasizes the need for aggressive therapy, including frequent examinations under anesthesia, wide debridement, systemic triple antibiotic therapy, diverting colostomy, aggressive wound care, and hyperalimentation.