Abstract
IntroductionWe report the first case to our knowledge where an ascending colorectal tumour presented as a necrotising lower leg infection.Case presentationWe describe the unusual presentation of a previously unknown caecal carcinoma in a 69-year-old Caucasian man, which presented as a rapidly spreading limb infection due to a perforated caecal adenocarcinoma. This case presented a diagnostic dilemma and we document the investigation and management in our patient and compare this to the current published literature.ConclusionsAlthough rare, this case highlights how leg swelling and in particular, thigh and gluteal swelling, have the potential to be an unusual presentation of a caecal carcinoma.
Highlights
We report the first case to our knowledge where an ascending colorectal tumour presented as a necrotising lower leg infection
We report a rare case of a caecal carcinoma presenting with right leg pain and swelling
His case was discussed by the colorectal multi-disciplinary team (MDT) and the decision was made to involve the tissue viability team to manage his leg wound with negative pressure dressings, allowing this to heal via secondary intention and delay any immediate abdominal surgery
Summary
We report a rare case of a caecal carcinoma presenting with right leg pain and swelling. After the CT scan, a surgical opinion was sought by the admitting medical team who recommended a blood transfusion and CT-guided percutaneous drainage that obtained pus from the retroperitoneal collection Due to his deteriorating clinical condition, our patient underwent an extensive right lateral thigh and lower leg fasciotomy and debridement down to the ankle. On day 21 he had an enteroscopy via his ileostomy, where ileocaecal biopsies taken demonstrated a moderately differentiated caecal adeoncarcinoma His case was discussed by the colorectal multi-disciplinary team (MDT) and the decision was made to involve the tissue viability team to manage his leg wound with negative pressure dressings, allowing this to heal via secondary intention and delay any immediate abdominal surgery. Our patient is currently undergoing a course of post-operative chemotherapy, given the incomplete excision, and has no signs of disease spread or recurrence
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