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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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Iemura S, Mori S, Kamiya M, Yamazaki K, Kobayashi T, Akagi M, Togawa D. Treatment of thigh abscess caused by retroperitoneal perforation of cecal cancer: A case report. Ann Med Surg (Lond) 2022; 79:103882. [PMID: 35860128 PMCID: PMC9289228 DOI: 10.1016/j.amsu.2022.103882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Iliopsoas and iliacus abscesses are caused by hematogenous and lymphatic infections and the spread of inflammation in neighboring organs. A small number of cases have been reported in which inflammation spread not only within the iliopsoas muscle but also to the thigh. Here we report a case of retroperitoneal infiltration and perforation of cecal cancer that caused extensive abscess formation from the iliacus muscle to the thigh. Case presentation An 80-year-old man who had undergone chemotherapy for cecal cancer had abdominal pain and right thigh pain without any particular attraction. CT images showed extensive abscess formation from the iliacus muscle to the subcutaneous part of the thigh due to retroperitoneal infiltration and perforation of cecal cancer. Ileocecal resection, colostomy, and retroperitoneal abscess drainage were performed for perforation of cecal cancer and pelvic abscess. Although the thigh was initially drained by a small incision, the infection did not heal. Extensive debridement and drainage were required for all of the contaminated areas, and after all the infection was completely cured. Clinical discussion The optimal treatment for an abscess that has spread from the inguinal region to the thigh is unclear. In this case, active debridement and drainage of the infected area were effective and should have been done early. Conclusion We believed that debridement and drainage should have been performed from the time of the first surgery not only by the small incision drainage but also for all of the contaminated areas when the infection had been widespread. ・The iliopsoas abscess may spread to the surrounding area in case its diagnosis is delayed. ・The optimal treatment for an abscess spreading from the inguinal region to the thigh is still controversial. ・Drainage by the small incision is not helpful when the infection has been spreading to the thigh, and all of the contaminated areas should also be exposed and active debridement and drainage are required.
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Affiliation(s)
- Shunki Iemura
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Shigeshi Mori
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Masato Kamiya
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Kenji Yamazaki
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Takaya Kobayashi
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Daisuke Togawa
- Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
- Corresponding author. Departments of Orthopaedics and Rheumatology, Kindai University Nara Hospital, 1248Otodacho, Ikoma, NARA, 630-0293, Japan.
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Karam C, Kozman MA, Fewtrell M, Ooi K. Perforated descending colon adenocarcinoma manifesting as necrotizing fasciitis. ANZ J Surg 2020; 90:E100-E102. [PMID: 32154966 DOI: 10.1111/ans.15812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 02/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Charbel Karam
- Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Mathew A Kozman
- Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Miriam Fewtrell
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kevin Ooi
- Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
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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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5
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Patel L, Teklay S, Wallace D, Skillman J. Perforated caecal carcinoma masquerading as lower limb necrotising fasciitis: lessons learnt. BMJ Case Rep 2018; 2018:bcr-2017-219412. [PMID: 29950356 DOI: 10.1136/bcr-2017-219412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old man was admitted with non-resolving right leg cellulitis. Subsequent skin changes over the calf and discharging pus suggested necrotising fasciitis. After several wound debridements of the leg and imaging, the patient was found to have an iliopsoas abscess due to a metastatic perforated caecal tumour extending along the medial thigh to the calf. No micro-organisms indicative of typical necrotising fasciitis were isolated from the wound. The patient had an ileocaecal resection, and his leg was reconstructed with a split thickness skin graft. He continues to do well postoperatively. This case highlights key lessons when dealing with an unusual presentation leading to challenges in diagnosis such as: (1) the need for good interspecialty liaison, (2) prompt senior review and plan, and (3) 'thinking outside the box' when faced with a diagnostic challenge.
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Affiliation(s)
- Lopa Patel
- Plastic Surgery and Burns, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Samuel Teklay
- Burns and Plastics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - David Wallace
- Plastic Surgery and Burns, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joanna Skillman
- Plastic Surgery and Burns, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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6
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Giuliani A, Caporale A, Demoro M, Scimò M, Galati F, Galati G. Silent Colon Carcinoma Presenting as a Hepatic Abscess. TUMORI JOURNAL 2018; 93:616-8. [DOI: 10.1177/030089160709300618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases. A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.
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Affiliation(s)
- Andrea Giuliani
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Alessandro Caporale
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Martino Demoro
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Michele Scimò
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Francesca Galati
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Gaspare Galati
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
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7
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Zhou H, Shao H, Ho JK, Wang X, Han C, Chen G. Rare Skin Fistulas Relating to Ascending Colonic Carcinoma: An Unusual Mode of Revelation. INT J LOW EXTR WOUND 2018; 17:48-53. [PMID: 29359609 DOI: 10.1177/1534734617750803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic or nonhealing wounds is a complex disease influenced by a multitude of factors, such as infection, ischemia, malnutrition, and diabetes and infrequently relates to retroperitoneal carcinoma. We present a case of an adenocarcinoma of ascending colon in a 68-year-old male who had lumbago and waist fistulas with retroperitoneal abscesses preceding other signs or symptoms of colonic malignancy. Supplemental information regarding the diagnosis and treatment of nonhealing wounds and colon carcinoma has also been included in the report. Adenocarcinoma of ascending colon is rarely associated with nonhealing wounds; nevertheless, it should be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term nonhealing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause.
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Affiliation(s)
- Hanlei Zhou
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Huawei Shao
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jon Kee Ho
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xingang Wang
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chunmao Han
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Guoxian Chen
- 1 Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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8
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Zalmanovich A, Lishner M, Reisfeld S. Clinical, diagnostic, and therapeutic features of patients admitted to acute care hospitals with trunk compared to lower limb cellulitis. Intern Emerg Med 2017; 12:957-962. [PMID: 28593451 DOI: 10.1007/s11739-017-1692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to report the clinical course and risk factors of trunk cellulitis, to identify diagnostic and therapeutic approaches, and compare them to patients with lower limb cellulitis. Medical records of adult patients with trunk cellulitis were reviewed and compared to an equal number of randomly selected patients with lower limb cellulitis. Demographic, clinical, and laboratory data were collected and analyzed using binary univariate and multivariate logistic regression analyses. Primary outcome was surgical drainage. Secondary outcomes were use of imaging studies, length of stay, readmission within 30 days, and 30-day mortality. During the study period, 74 patients were diagnosed with trunk cellulitis. Compared to patients with lower limb cellulitis, there are more women (57 vs. 39%, p = 0.032) and they are younger (mean age 59.7 vs. 68.4 years, p = 0.005). The only co-morbidity found as a significant risk factor for trunk cellulitis is malignancy (p = 0.017). These variables remain independent risk factors for trunk cellulitis after multivariate regression analysis. There is a trend toward more surgical interventions in the study group [6 (8%) patients vs. 1 (1%) with leg cellulitis, p = 0.116], and a longer hospital stay (5.8 days in the study group vs. 4.3 days in the control group, p = 0.025). Laboratory data are similar in both groups. There are risk factors for trunk cellulitis compared to lower limb cellulitis. However, diagnostic and therapeutic approaches are similar, except for a trend for more surgical interventions.
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Affiliation(s)
- Anat Zalmanovich
- Internal Medicine A, Meir Medical Center, 59 Tshernichovsky St., Kfar-Saba, Israel
| | - Michael Lishner
- Internal Medicine A, Meir Medical Center, 59 Tshernichovsky St., Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, 39040, Ramat-Aviv, Israel
| | - Sharon Reisfeld
- Infectious Diseases Unit, Hillel Yaffe Medical Center, Hashalom St., 36100, Hadera, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, 1 Efron St., Haifa, Israel.
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9
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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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10
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Ng NYB, Twoon M, Thomson SE. Psoas abscess and severe fasciitis due to a caecal carcinoma. BMJ Case Rep 2015; 2015:bcr-2014-207494. [PMID: 25631760 DOI: 10.1136/bcr-2014-207494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A man in his mid-50s presented with a painful and swollen right thigh and buttock. This was accompanied by a month long history of flank pain, back pain, vague abdominal pain, limp, fever and weight loss. On examination, there was extensive erythaema, heat, tenderness, oedema and crepitus over his right buttock and thigh. The patient was referred to plastic surgery to exclude necrotising fasciitis of the gluteal and thigh region. After CT imaging, a psoas abscess (PA) and caecal mass were identified. Subsequent right hemicolectomy, PA drainage and debridement of his right thigh were performed. This case reminds clinicians of the many non-specific ways a PA can present and that a high level of suspicion assists in making a timely diagnosis.
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11
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Mallia AJ, Ashwood N, Arealis G, Galanopoulos I. Retroperitoneal abscess: an extra-abdominal manifestation. BMJ Case Rep 2015; 2015:bcr-2014-207437. [PMID: 25576509 DOI: 10.1136/bcr-2014-207437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
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Affiliation(s)
- Alvin James Mallia
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - George Arealis
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Ilias Galanopoulos
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
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12
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Thigh abscess as an extension of psoas abscess: the first manifestation of perforated appendiceal adenocarcinoma: case report. Wien Klin Wochenschr 2014; 127:645-8. [PMID: 25412593 DOI: 10.1007/s00508-014-0651-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
A 65-year-old woman presented with a painful, swollen, red right thigh and the mild pain in the right abdomen without nausea, vomiting or diarrhoea that lasted for 1 week. Laboratory findings revealed elevated inflammatory markers. Computed tomography of the right thigh, abdomen and pelvis showed an abscess formation in the adductor muscles draining from the abscess that completely occupied the right retroperitoneum up to the diaphragm, dissecting downward through the inguinal canal. Appendix was enlarged with an appendicolith. Emergent exploratory laparotomy revealed a perforated appendix with psoas abscess. Pathohistological diagnosis revealed adenocarcinoma of the appendix. Thigh abscess is an uncommon condition with insidious clinical presentation. Therefore, early recognition and setting of the correct diagnosis enables adequate treatment avoiding additional complications and in some cases potential life-threatening conditions. When upper leg abscess is suspected or proven abdominal examination is mandatory.
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13
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Reginelli A, Russo A, Pinto A, Stanzione F, Martiniello C, Cappabianca S, Brunese L, Squillaci E. The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients. Int J Surg 2014; 12 Suppl 2:S181-S186. [DOI: 10.1016/j.ijsu.2014.08.345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/19/2023]
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14
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Carcinoma cecum presenting as right gluteal abscess through inferior lumbar triangle pathway--report of a rare case. Int Surg 2014; 99:371-3. [PMID: 25058767 DOI: 10.9738/intsurg-d-13-00116.1] [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: 11/17/2022] Open
Abstract
Gluteal abscess commonly follows intramuscular injections with contaminated needles. Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. A 50-year-old woman who was receiving intramuscular iron injections for anemia presented with a 10×10-cm abscess in the right gluteal region and a vague mass in the right iliac fossa. After investigations, a diagnosis of perforated carcinoma cecum with pericolic abscess tracking into the right gluteal region was made, and incision and drainage were done. Fine-needle aspiration cytology from the cecal growth revealed adenocarcinoma. Unfortunately, the patient was not willing to undergo definitive treatment. This case is being reported for its rarity and as an uncommon etiology for a common condition.
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Timbrell SJ, Straiton D, Breaks E, Sillah K, Khan N. Necrotising soft tissue infection of the lower limb due to a perforated caecal carcinoma: a case report. J Med Case Rep 2014; 8:80. [PMID: 24580985 PMCID: PMC3948044 DOI: 10.1186/1752-1947-8-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/16/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We report the first case to our knowledge where an ascending colorectal tumour presented as a necrotising lower leg infection. CASE PRESENTATION We describe the unusual presentation of a previously unknown caecal carcinoma in a 69-year-old Caucasian man, which presented as a rapidly spreading limb infection due to a perforated caecal adenocarcinoma. This case presented a diagnostic dilemma and we document the investigation and management in our patient and compare this to the current published literature. CONCLUSIONS Although rare, this case highlights how leg swelling and in particular, thigh and gluteal swelling, have the potential to be an unusual presentation of a caecal carcinoma.
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Affiliation(s)
- Simon J Timbrell
- Department of Surgery, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
| | - David Straiton
- Department of Surgery, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
| | - Elliot Breaks
- Queens Medical Centre, University of Nottingham Medical School, Derby Road, Nottingham NG7 2UH, UK
| | - Karim Sillah
- Department of Surgery, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
| | - Neil Khan
- Department of Surgery, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
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Yang JY, Lee JK, Cha SM, Joo YB. Psoas abscess caused by spontaneous rupture of colon cancer. Clin Orthop Surg 2011; 3:342-4. [PMID: 22162799 PMCID: PMC3232364 DOI: 10.4055/cios.2011.3.4.342] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 06/29/2010] [Indexed: 12/14/2022] Open
Abstract
Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.
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Affiliation(s)
- Jun-Young Yang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
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Yeo ESA, Ng KH, Eu KW. Perforated Colorectal Cancer: An Important Differential Diagnosis in All Presumed Diverticular Abscesses. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n8p375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Right gluteal abscess: an unusual presentation of perforated caecal adenocarcinoma. J Gastrointest Cancer 2010; 41:285-7. [PMID: 20480260 DOI: 10.1007/s12029-010-9155-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Colonic cancer presenting as a remote abscess in the gluteal region, abdominal wall, retroperitoneal region, groin or thigh is rare. CASE REPORT We report a case of advanced carcinoma of the caecum in an elderly lady without bowel symptoms presenting as right gluteal abscess. DISCUSSION In the differential diagnosis of gluteal/ upper thigh abscess the rare possibility of colonic cancer perforation as a cause should be considered.
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Rossetto A, Cerato F, Cedolini C, Arena MC, Bresadola V, Terrosu G. Post-Traumatic Right Lumbar Abscess as First Manifestation of Perforated Right Colon Cancer - A Case Report. Case Rep Oncol 2010; 3:40-44. [PMID: 20740157 PMCID: PMC2918841 DOI: 10.1159/000285986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Besides most common signs and symptoms suggesting a colic cancer, sometimes the clinical presentation can be difficult. Extra-abdominal abscess as a first sign of perforated colon carcinoma is a very unusual finding. We report a case of an old male patient, in bad general condition, with a post-traumatic finding of right lumbar abscess. After the percutaneous drainage with discharge of fecal material and a postponed explorative laparotomy, we discovered a perforated right colon carcinoma with a covered perforation affecting the duodenum wall and spreading to the hepatic bedand over to the back lumbar muscular wall. Because of the diffusion of the tumor, the patient was treated with palliative surgery with duodenum suture, right colon segment resection and subsequent ileocolic anastomosis with an uneventful postoperative course. The patient died 2 months later because of neoplastic cachexia.
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Affiliation(s)
- Anna Rossetto
- Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy
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Yoo JH, Kim EH, Song HS, Cha JG. A case of primary psoas abscess presenting as buttock abscess. J Orthop Traumatol 2009; 10:207-10. [PMID: 19936884 PMCID: PMC2784063 DOI: 10.1007/s10195-009-0074-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 10/23/2009] [Indexed: 12/23/2022] Open
Abstract
Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3 weeks. After 6 months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.
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Affiliation(s)
- Jae Ho Yoo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Bucheon, Gyeonggi-do, 420-767, South Korea.
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Subcutaneous Emphysema of a Neck and Extensive Phlegmon of a Lower Limb as the First Symptoms of Large Intestine Perforation. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Amitai A, Sinert R. Necrotizing Fasciitis as the Clinical Presentation of a Retroperitoneal Abscess. J Emerg Med 2008; 34:37-40. [DOI: 10.1016/j.jemermed.2007.03.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 07/25/2006] [Accepted: 11/16/2006] [Indexed: 10/22/2022]
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Tétart F, Carré D, Bravard P. Dermohypodermite lombaire secondaire à un abcès rétropéritonéal révélant un cancer du cæcum. Ann Dermatol Venereol 2007; 134:782-3. [DOI: 10.1016/s0151-9638(07)92540-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsai HL, Hsieh JS, Yu FJ, Wu DC, Chen FM, Huang CJ, Huang YS, Huang TJ, Wang JY. Perforated colonic cancer presenting as intra-abdominal abscess. Int J Colorectal Dis 2007; 22:15-9. [PMID: 16625373 DOI: 10.1007/s00384-006-0097-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial presentation is uncommon. MATERIALS AND METHODS A retrospective analysis was made between January 1998 and December 2003 at the Kaohsiung Medical University Hospital. Six colon cancer patients with intra-abdominal abscess as the initial presentation were enrolled into this study. Among them, two were men and four were women. RESULTS During the 6-year period, there were 756 patients with colonic carcinoma but only six of those patients (0.79%) presented with abscess formation as the initial finding. The initial pre-operative diagnosis was ruptured colonic diverticulitis with abscess formation in three patients, and the other three patients were as follows: one ruptured appendicitis with abscess, one right subcutaneous inguinal abscess, and one omphalitis with abdominal wall abscess. Subsequent colonoscopy was performed in two patients, and colon cancer was recognized. The most common associated symptoms/signs were palpable abdominal mass, abdominal pain, and anemia. All of them underwent a one-stage surgical procedure, and adjuvant chemotherapy was given. One patient died of peritoneal carcinomatosis and liver metastases 1 year post-operatively. The other five patients are still alive. CONCLUSIONS It is difficult to make an accurate diagnosis of abscess formation as the first evidence of colonic carcinoma pre-operatively. The one-stage resection of the lesion seems to be an acceptable treatment. For patients with intra-abdominal abscess, clinicians should be aware of this differential because it is easily ignored pre-operatively.
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Affiliation(s)
- Hsiang-Lin Tsai
- Division of General Surgery, Department of Surgery, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan
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Marron CD, McArdle GT, Rao M, Sinclair S, Moorehead J. Perforated carcinoma of the caecum presenting as necrotising fasciitis of the abdominal wall, the key to early diagnosis and management. BMC Surg 2006; 6:11. [PMID: 17010190 PMCID: PMC1615875 DOI: 10.1186/1471-2482-6-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 09/29/2006] [Indexed: 11/15/2022] Open
Abstract
Background Necrotising Fasciitis is a life threatening soft tissue infection which requires aggressive, early surgical management. Case presentation We present a rare case of a retroperitoneal perforation of a carcinoma of the caecum presenting as a necrotising fasciitis of the anterior abdominal wall. Conclusion This case highlights the importance of early aggressive debridement to healthy tissue limits, the consideration of a rare underlying cause, and the scope for plastic surgical reconstruction in order that aggressive initial surgery can be adequately performed.
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Affiliation(s)
- Conor D Marron
- Department of Surgery, Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, Northern Ireland, UK
- Department of Surgery, ICS, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Gerarde T McArdle
- Department of Surgery, Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, Northern Ireland, UK
| | - Milind Rao
- Department of Surgery, Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, Northern Ireland, UK
| | - Stephen Sinclair
- Department of Plastic Surgery, Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, Northern Ireland, UK
| | - John Moorehead
- Department of Surgery, Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, Northern Ireland, UK
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease. World J Gastroenterol 2006; 12:496-9. [PMID: 16489659 PMCID: PMC4066078 DOI: 10.3748/wjg.v12.i3.496] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, China
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Su CN, Hsieh DS, Sun GH, Yu DS, Fong CJ. Primary retroperitoneal abscess complicated with septic arthritis of the hip. J Chin Med Assoc 2006; 69:51-3. [PMID: 16447928 DOI: 10.1016/s1726-4901(09)70112-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Primary retroperitoneal abscess complicated with septic arthritis of the hip is an unusual disease. The insidious and occult nature of abscess coexistent with arthritis causes diagnostic delays, prolonged sepsis, and considerably higher morbidity and mortality. We herein present a case of gouty arthritis and avascular necrosis of the femoral head in a 41-year-old woman who complained of fever, right flank pain, body weight loss, swelling over her right lower limb, and 2 weeks of pain in the right hip. The computed tomographic scan showed a huge abscess (about 32 x 10 x 8 cm) over the right posterior pararenal space, with swelling of the right psoas, iliac, and obturator muscles. During surgery, the abscess was drained and sequestrectomy of the right hip was performed. Cultures of pus from the retroperitoneum and right hip showed Escherichia coil and Staphylococcus aureus. We review the literature and discuss possible causes.
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Affiliation(s)
- Chuan-Nan Su
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan, ROC
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Ushiyama T, Nakajima R, Maeda T, Kawasaki T, Matsusue Y. Perforated appendicitis causing thigh emphysema: a case report. J Orthop Surg (Hong Kong) 2005; 13:93-5. [PMID: 15872410 DOI: 10.1177/230949900501300118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of thigh emphysema resulting from perforated appendicitis. The patient was an 83-year-old man who had no apparent abdominal signs and was initially misdiagnosed as having psoas abscess. Magnetic resonance imaging of the pelvis revealed appendicitis, and a barium enema showed a leakage of enhanced contrast material from the appendix region down into the thigh. A retroperitoneal perforation of the retrocaecal appendix without peritonitis was diagnosed. The patient underwent an appendectomy and curettage of the retroperitoneal and psoas muscle spaces, as well as the thigh. He recovered gradually, though the abscess had extended into the hip joint and resulted in osteomyelitis, requiring an additional procedure of resection arthroplasty. The patient fully recovered with no signs of infection one year postoperatively.
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Affiliation(s)
- T Ushiyama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta, Otsu, Japan.
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