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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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Granger L, Rao M, Rambani R. Extra-abdominal manifestations of retroperitoneal infection: a case of popliteal sinus secondary to duodenal ulcer. Ann R Coll Surg Engl 2020; 102:e1-e4. [PMID: 32734780 DOI: 10.1308/rcsann.2020.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function tests. A purulent sinus developed in the popliteal fossa and computed tomography of the abdomen revealed a right-sided retroperitoneal collection with gas, extending to the right pelvis and inguinal region. The popliteal fossa sinus and retroperitoneal collection were identified as a single pathology through computed tomography, magnetic resonance imaging and culture of identical organisms. At laparotomy, perforated duodenal ulcer disease was identified as the cause of the retroperitoneal abscess. Clinicians should seek to exclude retroperitoneal sources of infection in cases of lower leg infection, including perforated duodenal ulcer, caecal adenocarcinoma and appendicitis.
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Affiliation(s)
- L Granger
- Trauma and Orthopaedic Department, Pilgrim Hospital, Boston, Lincolnshire, UK
| | - M Rao
- Department of General Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK
| | - R Rambani
- Trauma and Orthopaedic Department, Pilgrim Hospital, Boston, Lincolnshire, UK
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