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Zhou J, Wan S, Li C, Ding Z, Qian Q, Yu H, Li D. Retroperitoneal abscess as a presentation of colon cancer: The largest case set analysis to date, which extracted from our unit and the literature. Front Oncol 2023; 13:1198592. [PMID: 37941542 PMCID: PMC10629392 DOI: 10.3389/fonc.2023.1198592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Objective Colon cancer with retroperitoneal abscess is a rare and easily misdiagnosed disease and has only been reported via case. There is an urgent need to conduct a dataset analysis for such patients, which is crucial to improving the survival rate and quality of life of these patients. Methods Patients with colon cancer associated with retroperitoneal abscess were extracted from our hospital and the PubMed, EMBASE and Web of Science databases. Clinical information, including the patients' basic characteristics, clinical symptoms, laboratory tests, imaging examinations, treatment methods and prognosis was analyzed. Results Sixty-one patients were analyzed, with an average age of 65 years. The proportions of right and left colon cancers were 63.9% and 36.1%, respectively. A total of 98.0% of the patients had adenocarcinoma. Many patients have insidious symptoms such as fever and weight loss. At the first medical visit, pain was the most common symptom (71%), with pain in the thigh (21.8%), abdomen (21.8%), and waist and back (14.5%) ranking among the top three. The misdiagnosis rate of the patients referred to our department was 75%, while the overall misdiagnosis rate in the literature was 43.9%. Laboratory tests show that these patients often have elevated white blood cells and anemia. CT examination showed that 87.2% of patients had an iliopsoas muscle abscess, and tumors were not simultaneously detected in 37.2%. A total of 33.9% of patients had local abscesses of the iliopsoas muscle, 26.4% had drainage into the subcutaneous tissue of the waist and upper buttocks, and 22.6% had drainage around the adductor muscle group of the thigh. These patients have a variety of treatments, and many patients have undergone multiple and unnecessary treatments. Thirteen patients died after surgery, and 6 died in the hospital, of whom four were patients undergoing direct surgery, and the other 7 died after discharge due to cachexia. Conclusion Colorectal cancer with retroperitoneal abscess is a relatively rare and easily misdiagnosed subtype of colon cancer. It is more likely to occur in right-sided colon adenocarcinoma. The main clinical symptom is pain caused by the drainage of pus to the corresponding areas of the waist, abdomen, and legs. CT is the preferred diagnostic method. Actively treating the abscess and then transitioning to standard colon cancer treatment can prevent patient death and improve treatment quality.
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Affiliation(s)
- Junmin Zhou
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Departments of Anorectal Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, Hubei, China
| | - Songlin Wan
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, Hubei, China
| | - Chunguang Li
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, Hubei, China
| | - Zhao Ding
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, Hubei, China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, Hubei, China
| | - Hao Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Daojiang Li
- Department of Colorectal and Anal Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, Hubei, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
- Department of Colorectal and Anal Surgery, Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, Hubei, China
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Medina Velasco AA, Gemio Del Rey I, de la Plaza Llamas R, Arteaga Peralta V, Ramia JM. Inguinal abscess as presentation of a right colon cancer. A systematic review. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:139-143. [PMID: 31985253 DOI: 10.17235/reed.2020.5887/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Perforation in colorectal cancer is an uncommon condition, and neoplastic invasion of the abdominal wall with local infection is even rarer. Our objective is to present the case of an 84-year-old male with right colon cancer that manifested as an inguinal abscess, and also to perform a systematic review of the literature in PubMed, EMBASE, and Web of Science. A total of 59 cases in retrospective studies were found. Median age was 64 years, thirty cases were men and twenty-nine were women (51% and 49%, respectively). The most common location was the right colon with 27 cases (46%), followed by the left colon with 18 cases (31%), 12 cases in the transverse colon (20%), and 2 cases with colonic synchronous neoplasm (3%). Surgery was performed in two or more occasions for 33 cases (60%), and on one occasion for 21 cases (38%); medical treatment alone was administered in one case (2%). The most common histological type was adenocarcinoma (64%), followed by its mucinous variant (22%). There was recurrence in 33% of cases. Mortality at follow-up was 47%. As a limitation of our study, follow-up was heterogeneous, making it impossible to interpret long-term results regarding the influence of treatment on patient survival, also difficulted by the urgent nature of the condition and its exceptional incidence. Further studies are needed with prospective data collection on the management of colorectal cancer in the emergency setting, standardizing follow-up in order to facilitate an adequate analysis of the prognosis of the disease.
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Affiliation(s)
| | - Ignacio Gemio Del Rey
- Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, España
| | | | | | - José Manuel Ramia
- Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, España
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Ruscelli P, Renzi C, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Cirocchi R, Lancia M, Gioia S, Tabola R. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore) 2018; 97:e13176. [PMID: 30407351 PMCID: PMC6250550 DOI: 10.1097/md.0000000000013176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs. PATIENTS' CONCERNS A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign. DIAGNOSIS In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection. INTERVENTIONS In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess. OUTCOMES The first patient underwent right colectomy with ileostomy in the 7 postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive. LESSONS The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.
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Affiliation(s)
- Paolo Ruscelli
- Emergency Surgery Unit, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona
| | | | - Andrea Polistena
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | | | - Nicola Avenia
- General Surgery and Surgical Specialties Unit, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Military Medical Academy-Sofia, Department of Surgery, Sofia, Bulgaria
| | | | - Massimo Lancia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Sara Gioia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, Terni, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Medical University, Wroclaw. Poland
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Pouriki S, Skalistir M, Zoumpouli C, Alexakis N. Necrotising fasciitis of the left leg caused by perforated caecal adenocarcinoma. Ann R Coll Surg Engl 2017; 99:e223-e224. [PMID: 29022786 DOI: 10.1308/rcsann.2017.0138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An 82-year-old man presented with abdominal pain and a painful and swollen left thigh. On examination there was oedema, tenderness and crepitus with skin discoloration of the left thigh. Computed tomography showed retroperitoneal perforation of the caecum and necrotising fasciitis of the left thigh. A right hemicolectomy and repeated fasciotomies of the left thigh with debridement of necrotic tissue were performed but the patient died of multi-organ failure. Histology showed a pT4aN2c caecal adenocarcinoma. This is a unique presentation of a retroperitoneal caecal perforation and acts as a reminder that unexplained severe fasciitis of the thigh may be caused by an intra-abdominal pathology.
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Affiliation(s)
- S Pouriki
- Intensive Care Unit, Hippocratio NHS Hospital , Athens , Greece
| | - M Skalistir
- Department of Anesthesiology, Hippocratio NHS Hospital , Athens , Greece
| | - C Zoumpouli
- Department of Histopathology, Hippocratio NHS Hospital , Athens , Greece
| | - N Alexakis
- Department of Surgery, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
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Das A, Hureibi K, Tayyab M, McCullough P. Caecal cancer presenting as leg erythema and a lung opacity. BMJ Case Rep 2017; 2017:bcr-2017-220752. [PMID: 28882933 DOI: 10.1136/bcr-2017-220752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Necrotising infection of the lower limb is a rare presentation for colorectal malignancy. We report a case of a perforated caecal adenocarcinoma presenting with right leg erythema, pain and swelling in the presence of a right lower lobe lung opacity. Following initial debridement and washout, CT imaging demonstrated a thickened terminal ileum, caecum and appendix, in keeping with primary malignancy. This fed the right-sided lower limb sepsis tracking down from the medial aspect of the psoas muscle to give rise to the multiloculated collection seen in the adductor compartment. The lung lesion measured 16 mm and was metastatic. The patient was successfully managed with a subtotal colectomy and an end ileostomy. The biopsy confirmed an adenocarcinoma (T4N1M1). We highlight the importance of perforated colonic carcinoma as a leading differential for lower limb abscesses. Suspicions should be raised further if accompanied by rounded opacifications on plain film radiography of the lungs.
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Affiliation(s)
- Archik Das
- Department of Colorectal Surgery, University Hospital Coventry, Coventry, West Midlands, UK
| | - Khalid Hureibi
- Department of Colorectal Surgery, University Hospital Coventry, Coventry, West Midlands, UK
| | - Muhammad Tayyab
- Department of Colorectal Surgery, University Hospital Coventry, Coventry, West Midlands, UK
| | - Peter McCullough
- Department of Colorectal Surgery, University Hospital Coventry, Coventry, West Midlands, UK
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Hsu WH, Lai LJ, Peng KT, Lee CY. Acute pyogenic inguinal abscess from complex soft-tissue infection or intra-abdominal pathology. Surg Infect (Larchmt) 2014; 15:467-73. [PMID: 24818646 DOI: 10.1089/sur.2012.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked. METHODS A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed. RESULTS Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses. CONCLUSIONS Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.
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Affiliation(s)
- Wei-Hsiu Hsu
- 1 Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi , Chia Yi, Taiwan
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Lampropoulos P, Liarmakopoulos E, Markakis C, Voultsos M, Marinou TR, Marinis A, Hadjimarkou A, Rizos S. Colon cancer perforation presenting as a strangulating ventral hernia. Case Rep Oncol 2012; 5:17-21. [PMID: 22379472 PMCID: PMC3290034 DOI: 10.1159/000335682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Colorectal cancer remains the second leading cause of death from malignant disease. Despite improvements in the treatment modalities offered to patients, more than half of the operated patients die from the disease. The most common presenting symptoms of colonic carcinoma are changes in bowel habits, bleeding, abdominal pain, abdominal mass, stools mixed with mucus or not, weight loss, anorexia, and other characteristics related to metastasis. Here, the case of a 74-year-old female patient with colon cancer perforation presenting as a strangulating ventral hernia and a mini-review of the current literature are presented.
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