%0 Journal Article
%T A Rare Case of Perforated Descending Colon Cancer Complicated with a Fistula and Abscess of Left Iliopsoas and Ipsilateral Obturator Muscle
%A Alban Cacurri
%A Gaspare Cannata
%A Stefano Trastulli
%A Jacopo Desiderio
%A Antongiulio Mangia
%A Olga Adamenko
%A Eleonora Pressi
%A Giorgio Giovannelli
%A Giuseppe Noya
%A Amilcare Parisi
%J Case Reports in Surgery
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/128506
%X Perforation of descending colon cancer combined with iliopsoas abscess and fistula formation is a rare condition and has been reported few times. A 67-year-old man came to our first aid for an acute pain in the left iliac fossa, in the flank, and in the ipsilateral thigh. Ultrasonography and computed tomography revealed a left abdominal wall, retroperitoneal, and iliopsoas abscess that also involved the ipsilateral obturator muscle. It proceeded with an exploratory laparotomy that showed a tumor of the descending colon adhered and perforated in the retroperitoneum with abscess of the iliopsoas muscle on the left-hand side, with presence of a fistula and liver metastases. A left hemicolectomy with drainage of the broad abscess was performed. Pathologic report findings determined adenocarcinoma of the resected colon. 1. Introduction Infections of the retroperitoneal space have troubled physicians in all disciplines for decades because of remarkable diagnosis and treatment problems along with a mortality rate which is around 20% [1]. Retroperitoneal abscesses with no triggering cause are rare. In the past the most frequent were the ¡°cold¡± ones as tuberculosis, whereas today the ¡°hot¡± ones, secondary to Crohn¡¯s disease, pyelonephritis, and diverticulitis, are most frequent [2]. It is very rare that a retroperitoneal abscess, particularly in the iliopsoas muscle, is caused by a perforation of a cancer of the descending colon. In fact colon cancer, which represents the most frequent tumor of the digestive tract [3], involves bleeding, perforative, and occlusive events among the most common complications; these latter ones are more suggestive of a tumor of the descending colon. Furthermore the invasion of adjacent organs can be found frequently in case of cancer of the left colon in an advanced stage like a T4 according to the TNM classification and staging of the 2010 [4]. But an event like the perforation with invasion of the abdominal wall and the possible formation of an abscess in the retroperitoneal space is relatively rare [5]. In cases where a colorectal cancer shows atypical clinical findings the diagnosis is very difficult; moreover, the delay of the diagnosis and the inadequate clinical management represent a major cause of an increase in morbidity and mortality [5¨C8]. Here is a case of cancer of the descending colon which was presented with an unusual abscess of the left iliopsoas muscle and ipsilateral obturator muscle. 2. Case Report A 67-year-old man came to our first aid for an acute pain in the left iliac fossa, in the flank, and in the
%U http://www.hindawi.com/journals/cris/2014/128506/