Perforated cecal carcinoma presenting as thigh emphysema

Area of Science:

• Gastroenterology
• Surgical Oncology
• Radiology

Background:

• Retroperitoneal gastrointestinal perforation is a rare but serious complication.
• Elderly patients may present with atypical symptoms, complicating diagnosis.
• Cecal carcinoma is a common malignancy that can lead to perforation.

Observation:

• A case of perforated cecal carcinoma presented with right hip pain and thigh emphysema.
• Radiographs initially suggested a perforated intra-abdominal viscus.
• The patient, an elderly male, had minimal initial abdominal complaints.

Findings:

• Surgical intervention included hemicolectomy and debridement of necrotic muscle.
• The patient initially showed improvement post-operatively.
• Despite initial surgical success, the patient experienced a fatal cardiac arrest after a dyspneic episode.

Implications:

• Thigh emphysema can be an unusual presenting sign of retroperitoneal gastrointestinal perforation, especially in the elderly.
• Early recognition and surgical management are crucial for perforated intra-abdominal viscus.
• This case underscores the importance of considering uncommon presentations in geriatric surgical patients.