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A large iliopsoas abscess due to colon cancer complicated by bowel obstruction: A case report
Shuya Nohmi1, Shojirokazunori Ikenaga2, Akiko Itaya2
1Department of Orthopaedic Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan.
Introduction:
Iliopsoas abscesses (IPAs) associated with bowel obstruction due to colon cancer are rare, and there is no consensus regarding treatment strategies.
Presentation Of Case:
A 63-year-old man presented with swelling and pain in the right iliac region. Imaging studies revealed an IPA expanding from the psoas major muscle and retroperitoneal space subcutaneously around the right ilium. After percutaneous drainage, the patient developed bowel obstruction secondary to colon cancer. Hemicolectomy and preventive ileostomy were performed at the gastrointestinal surgery department, and chemotherapy was administered at the medical oncology department after ileostomy closure. Three months later, local recurrence was confirmed in the right iliac region, and the recurrent lesion, including the ilium, was widely resected. One and a half years after the reoperation, there was no recurrence.
Discussion:
An IPA due to colorectal cancer without obvious perforation can also occur, and the treatment of IPAs depends on their size, location, shape, and presence of gas. Minimally invasive and staged treatment is preferable for IPAs due to colorectal cancer because the surgical mortality rate for colorectal cancer with local abscesses is high.
Conclusion:
Colorectal cancer should be considered as a cause of IPAs. Treatment of IPAs caused by colon cancer should be performed in a less invasive manner after considering their size, location, shape, and the presence of gas. Cooperation between gastrointestinal surgeons and oncologists is essential for managing patients with an IPA due to colon cancer complicated by bowel obstruction.
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