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 [5–8]. 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
References
[1]
J. T. Crepps, J. P. Welch, and R. Orlando III, “Management and outcome of retroperitoneal abscesses,” Annals of Surgery, vol. 205, no. 3, pp. 276–281, 1987.
[2]
A. Martino, F. Catuogno, P. Festa et al., “Retroperitoneal abscess by suppurative psoas. Case report,” Annali Italiani di Chirurgia, vol. 79, pp. 377–382, 2008.
[3]
“Colorectal cancer,” in World Cancer Report 2003, B. W. Stewart and P. Kleihues, Eds., pp. 198–202, HICP Press, Lyon, France.
[4]
“AJCC: colon and rectum,” in AJCC Cancer Staging Manual, S. B. Edge, D. R. Byrd, C. C. Compton, A. G. Fritz, F. L. Greene, and A. Trotti, Eds., pp. 143–164, Springer, New York, NY, USA, 7th edition, 2010.
[5]
D. D. T. Maglinte and H. M. Pollack, “Retroperitoneal abscess: a presentation of colon carcinoma,” Gastrointestinal Radiology, vol. 8, no. 2, pp. 177–181, 1983.
[6]
R. Cirocchi, S. Trastulli, I. Abraha et al., “Non-resection versus resection for an asymptomatic primary tumour in patients with unresectable stage IV colorectal cancer,” Cochrane Database of Systematic Reviews, vol. 8, Article ID CD008997, 2012.
[7]
R. Cirocchi, E. Farinella, S. Trastulli et al., “Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis,” Surgical Oncology, vol. 22, no. 1, pp. 14–21.
[8]
R. Cirocchi, E. Farinella, S. Trastulli, F. Sciannameo, and R. A. Audisio, “Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review,” Colorectal Disease, vol. 14, no. 6, pp. 671–683, 2012.
[9]
H. Mynter, “Acute psoitis,” Buffalo Medical and Surgical Journal, vol. 21, pp. 202–210, 1881.
[10]
S. N. Agrawal, A. J. Dwivedi, and M. Khan, “Primary psoas abscess,” Digestive Diseases and Sciences, vol. 47, no. 9, pp. 2103–2105, 2002.
[11]
M. van den Berge, S. de Marie, T. Kuipers, A. R. Jansz, and B. Bravenboer, “Psoas abscess: report of a series and review of the literature,” Netherlands Journal of Medicine, vol. 63, no. 10, pp. 413–416, 2005.
[12]
M. A. Ricci, F. B. Rose, and K. K. Meyer, “Pyogenic psoas abscess: worldwide variations in etiology,” World Journal of Surgery, vol. 10, no. 5, pp. 834–843, 1986.
[13]
I. Gruenwald, J. Abrahamson, and O. Cohen, “Psoas abscess: case report and review of the literature,” Journal of Urology, vol. 147, no. 6, pp. 1624–1626, 1992.
[14]
M. Paley, P. S. Sidhu, R. A. Evans, and J. B. Karani, “Retroperitoneal collections—aetiology and radiological implications,” Clinical Radiology, vol. 52, no. 4, pp. 290–294, 1997.
[15]
R. Zissin, G. Gayer, E. Kots, M. Werner, M. Shapiro-Feinberg, and M. Hertz, “Iliopsoas abscess: a report of 24 patients diagnosed by CT,” Abdominal Imaging, vol. 26, no. 5, pp. 533–539, 2001.
[16]
N. H. Qureshi, D. P. O'Brien, and D. A. Allcutt, “Psoas abscess secondary to discitis: a case report of conservative management,” Journal of Spinal Disorders, vol. 13, no. 1, pp. 73–76, 2000.
[17]
T. R. Walsh, J. R. Reilly, E. Hanley, M. Webster, A. Peitzman, and D. L. Steed, “Changing etiology of iliopsoas abscess,” American Journal of Surgery, vol. 163, no. 4, pp. 413–416, 1992.
[18]
I. H. Mallick, M. H. Thoufeeq, and T. P. Rajendran, “Iliopsoas abscesses,” Postgraduate Medical Journal, vol. 80, no. 946, pp. 459–462, 2004.
[19]
J.-J. Huang, M.-K. Ruaan, R.-R. Lan, and M.-C. Wang, “Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome,” Journal of Infection, vol. 40, no. 3, pp. 248–255, 2000.
[20]
A. Rehman Alvi, Z. U. Rehman, and Z. U. Rehman G Nabi, “Pyogenic psoas abscess: case series and literature review,” Tropical Doctor, vol. 40, no. 1, pp. 56–58, 2010.
[21]
N. Mandava, S. Kumar, W. F. Pizzi, and I. J. Aprile, “Perforated colorectal carcinomas,” American Journal of Surgery, vol. 172, no. 3, pp. 236–238, 1996.
[22]
A. Okita, Y. Kubo, M. Tanada, A. Kurita, and S. Takashima, “Unusual abscesses associated with colon cancer: report of three cases,” Acta Medica Okayama, vol. 61, no. 2, pp. 107–113, 2007.
[23]
K. N. Lee, H. L. Lee, J. H. Yoon et al., “A case of mucinous adenocarcinoma of the colon presenting with psoas abscess,” The Korean Journal of Gastroenterology, vol. 52, no. 2, pp. 120–123, 2008.
[24]
Y. Takakura, S. Ikeda, M. Yoshimitsu et al., “Retroperitoneal abscess complicated with necrotizing fasciitis of the thigh in a patient with sigmoid colon cancer,” World Journal of Surgical Oncology, vol. 7, article 74, 2009.
[25]
J.-Y. Yang, J.-K. Lee, S.-M. Cha, and Y.-B. Joo, “Psoas abscess caused by spontaneous rupture of colon cancer,” Clinics in Orthopedic Surgery, vol. 3, no. 4, pp. 342–344, 2011.
[26]
C.-H. Lo, Y.-S. Yang, and C.-L. Ho, “Rectal adenocarcinoma with bilateral psoas muscle abscess: case report and review of the literature,” Journal of Medical Sciences, vol. 33, no. 4, pp. 225–227, 2013.
[27]
K. Tsukuda, E. Ikeda, T. Miyake et al., “Abdominal wall and thigh abscess resulting from the penetration of ascending colon cancer,” Acta Medica Okayama, vol. 59, no. 6, pp. 281–283, 2005.
[28]
C. M. Peterson, J. G. Allison, and C. C. Lu, “Psoas abscess resulting from perforating carcinoma of the sigmoid colon. Report of a case,” Diseases of the Colon and Rectum, vol. 26, no. 6, pp. 390–392, 1983.
[29]
M. Michowitz, D. Avnieli, I. Lazarovici, and M. Solowiejczyk, “Perforation complicating carcinoma of colon,” Journal of Surgical Oncology, vol. 19, no. 1, pp. 18–21, 1982.
[30]
A. P. Panwalker, “Unusual infections associated with colorectal cancer,” Reviews of Infectious Diseases, vol. 10, no. 2, pp. 347–364, 1988.
