ANTERIOR ABDOMINAL WALL ABSCESS A RARE PRESENTATION OF LEFT SIDED COLONIC CARCINOMA: A DIAGNOSTIC CHALLENGE FOR A GENERAL SURGEON

Background: 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. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20 x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks. She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this differential because it is easily ignored pre-operatively.