Necrotizing fasciitis (NF) is a life threatening polymicrobial infection that rapidly invades tissue planes, ultimately causing sepsis and death. It is commonly seen in advanced age, diabetes and immunosuppression. Patients are septic on presentation and the diagnosis is made on clinical grounds in the presence of crepitus. Rare causes of NF such as perforated colorectal malignancies are extremely rare and can be very difficult to identify in the absence of imaging. Computed tomography (CT) is the gold standard imaging modality which can demonstrate subcutaneous emphysema, delineate tissue planes, identify occult lesions and guide operative planning. Management involves resuscitation, intravenous antibiotics and emergency surgery for septic and/or oncological control. The number of complicated delayed presentations of NF at a tertiary centre has more than tripled since the start of COVID-19. In particular a patient presenting to our tertiary centre with a large inguinal lump and scrotal swelling was found to have a perforated rectal adenocarcinoma on CT, extending into the inguinal canal and scrotum. He was aggressively resuscitated, commenced on broad spectrum antibiotics and underwent surgical debridement and laparoscopic loop colostomy formation. A positron emission tomography (PET) and MRI scan revealed a T4 rectal cancer with seminal vesicle invasion and multiple large mesorectal fascia nodes involving the left sacrospinous ligament. He underwent chemo radiotherapy with good response and proceeded to a pelvic exenteration, ileal conduit formation and sacrectomy at a specialized exenteration unit. The purpose of this presentation is to highlight the impact of delayed presentations and management of NF due to the COVID-19 pandemic. Such delayed presentations have accounted for increased collateral damage and sequelae of surgical pathology. This case is unique as it is the first reported instance of Fournier’s gangrene secondary to a perforated rectal cancer masquerading as an inguinal hernia. Conclusion and significance: The COVID-19 pandemic has accounted for an increased severity of collateral damage due to delayed presentations. This has also uncovered extremely rare surgical pathologies. As the pandemic progresses, the complexity of such cases will undoubtedly continue to rise.