SHM Converge Scientific Abstract ePoster Gallery-Following a Trail of Gaseous Breadcrumbs to a Haustra Neoplasm

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This case describes a 40-year-old Hispanic man with no significant past medical history who presented with three weeks of right thigh pain, swelling, and a draining brown fluid collection, along with recent weight loss and recurrent melena. Initial concern was for a thigh abscess or necrotizing soft tissue infection, supported by extensive subcutaneous gas on imaging and elevated inflammatory markers. He was started on broad-spectrum IV antibiotics and underwent incision and drainage with drain placement. Wound cultures grew Klebsiella pneumoniae.<br /><br />Because of his weight loss, anemia, and gastrointestinal bleeding history, additional imaging was obtained. CT of the abdomen and pelvis revealed a rectal mass and a perirectal abscess consistent with rectal perforation. Flexible sigmoidoscopy showed a 10 cm circumferential polypoid rectal mass extending from near the dentate line to 12 cm into the rectum. Biopsy confirmed poorly differentiated rectal adenocarcinoma, and MRI staged the tumor as T3d N2b. He subsequently underwent laparoscopic diverting loop colostomy, with plans for neoadjuvant chemoradiation therapy.<br /><br />The report highlights that colorectal cancer can present in unusual ways, including abscess formation or infection in adjacent structures, which may obscure the underlying malignancy. Although colorectal cancer is more common in older adults, it is increasingly being diagnosed in younger patients, who often have more advanced disease and worse outcomes. The key lesson is to maintain a high index of suspicion for malignancy in patients with concerning systemic symptoms, even when the acute presentation appears infectious.

Asset Subtitle

Vineet Gupta

Meta Tag

Author List Daniel Bouland, Joseph Toth, Vineet Gupta

Category Clinical Vignettes

Concept Soft Tissue Abscess

Concept Colorectal Cancer

Concept Rectal Perforation

Concept Locally Advanced Rectal Cancer

Concept Local Invasion

Distinguished Non-Finalist

Presenter Organization University of California, San Diego (UCSD)

Presenting Author Vineet Gupta

Track Adult

Keywords

rectal adenocarcinoma

colorectal cancer

thigh abscess

Klebsiella pneumoniae

rectal perforation

perirectal abscess

melena

weight loss

young patient

neoadjuvant chemoradiation

Soft Tissue Abscess

Colorectal Cancer

Rectal Perforation

Locally Advanced Rectal Cancer

Local Invasion