[A Case of Descending Colon Cancer with Splenic Abscess and Portal Venous Gas]

The patient was an 83-year-old woman who underwent surgery at our orthopedic department for a lumbar compression fracture. On the second postoperative day, she developed fever and massive lower gastrointestinal bleeding. CT imaging revealed wall thickening of the descending colon, an abscess extending from the surrounding area to the spleen, and portal venous gas. The diagnosis was perforation of the descending colon, retroperitoneal abscess, and splenic abscess, leading to emergency surgery. Intraoperative findings suggested that the descending colon had perforated into the retroperitoneal space, forming an abscess, which had penetrated the spleen, creating a fistula. A hard mass was palpable at the perforation site of the descending colon, raising suspicion of cancer. Partial colectomy with combined resection of spleen and intra- abdominal irrigation and drainage were performed. Pathological findings confirmed the diagnosis of perforation due to descending colon cancer. No obvious splenic infiltration was observed, and it was considered that gas produced by gas-producing bacteria in the splenic abscess had migrated into the portal vein. Postoperatively, the patient developed disseminated intravascular coagulation(DIC), but improved with treatment. The patient was transferred to a rehabilitation facility on the 41st postoperative day. Three months postoperatively, multiple liver metastases and peritoneal metastases were detected, and palliative care was initiated at the transfer facility.