Presentation
Left-sided abdominal pain a few days ago, fever, and leukocytosis.
Patient Data
Left upper abdominal quadrant multiple locules of mixed fluid and gas densities, surrounding with marked fat edema, closely related to the colonic splenic flexure wall and based upon the peritoneum and left lateral abdominal wall suggesting abscesses. Suspected colonic wall focal perforation.
Segmental circumferential wall thickening of the colonic splenic flexure with marked luminal compromise suggesting a mass lesion.
The colon proximal to this segment (cecum, ascending and transverse) is seen as redundant, markedly loaded with contents and opacified with the enteric contrast. The contrast can’t pass through the stenotic colonic lesion and the distal colon is not significantly distended.
The small bowel is not distended inferring competent ileocecal valve.
Few minute hepatic focal lesions appear hypo enhancing in the portal phase.
Few right simple renal cysts is noted.
Case Discussion
Paracolic inflammation and abscesses prompted an investigation for an underlying lesion, particularly in the context of partial colonic obstruction. A stenotic colonic wall lesion at the splenic flexure was identified, likely malignant.
Although rare, this presentation is documented in the literature as an uncommon manifestation of colonic malignancy. It arises from a transmural invasion of the colonic wall and increased intraluminal pressure, leading to perforations. The splenic flexure, as a watershed area of the colon, is especially vulnerable to ischemia and subsequent perforation.
In this case, the patient underwent drainage of the paracolic abscess and was transferred to a specialized oncologic center for further evaluation and management of the primary colonic lesion. No additional data were available at the time.
Unable to process the form. Check for errors and try again.