Transverse Colon Mucinous Adenocarcinoma Presenting as a Left Illiac Region Abscess and Fecal Fistula in Young Adult: Case Report

Afif Iman Hidayat; Sekar Arum Nuring  Kurnia

doi:10.59188/jurnalsosains.v6i10.32799

Authors

Afif Iman Hidayat RSUD dr. R. Soedjati
Sekar Arum Nuring Kurnia RSUD dr. R. Soedjati

DOI:

https://doi.org/10.59188/jurnalsosains.v6i10.32799

Keywords:

Mucinous adenocarcinoma, Transverse colon, Iliac abscess, Lumbar abscess, Early-onset colorectal cancer, Diagnostic pitfall

Abstract

Colorectal cancer in young adults may present with atypical manifestations, including recurrent abdominal wall abscesses that can obscure an underlying malignancy. This case report aimed to describe the diagnostic course and surgical management of a young woman with a perforated transverse colon tumor presenting as a recurrent left iliac region abscess. A retrospective descriptive case report was prepared using medical records from two hospital admissions, including clinical examinations, laboratory findings, contrast-enhanced abdominal computed tomography (CT), intraoperative findings, and histopathological reports. A 35-year-old woman initially presented with a painful left iliac region mass, a body mass index of 14.98 kg/m², a hemoglobin level of 7.0 g/dL, and a leukocyte count of 21,250/µL. Incision and drainage were performed, while histopathological examination of the abscess wall revealed nonspecific chronic inflammation. One month later, the abscess recurred and extended into the suprapubic and right lumbar regions. Contrast-enhanced CT demonstrated extensive abscess formation, and exploratory laparotomy revealed a perforated transverse colon mass. Abscess drainage, transverse colectomy, and double-barrel stoma formation were performed. Histopathological examination of the resected specimen revealed low-grade adenocarcinoma, not otherwise specified (NOS), with tumor-free proximal and distal resection margins. This clinical course illustrated the limitations of superficial abscess-wall biopsy in detecting an underlying colon malignancy. Recurrent iliac region abscesses accompanied by systemic abnormalities warrant further evaluation for underlying intra-abdominal pathology. Integration of cross-sectional imaging, intraoperative findings, and definitive histopathological examination can facilitate accurate diagnosis and guide appropriate management.

References

Akimoto, N., Ugai, T., Zhong, R., Hamada, T., Fujiyoshi, K., Giannakis, M., Wu, K., Cao, Y., Ng, K., & Ogino, S. (2021). Rising incidence of early-onset colorectal cancer—A call to action. Nature Reviews Clinical Oncology, 18(4), 230–243. https://doi.org/10.1038/s41571-020-00445-1

Aldriwesh, M. G. (2024). Comparative analysis of the clinical aspects of colorectal cancer in young adult and older adult patients in Saudi Arabia. Frontiers in Oncology, 14, Article 1460636. https://doi.org/10.3389/fonc.2024.1460636

Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834

Dekker, E., Tanis, P. J., Vleugels, J. L. A., Kasi, P. M., & Wallace, M. B. (2019). Colorectal cancer. The Lancet, 394(10207), 1467–1480. https://doi.org/10.1016/S0140-6736(19)32319-0

Fritz, C. D. L., Otegbeye, E. E., Zong, X., Demb, J., Nickel, K. B., Olsen, M. A., Mutch, M., Davidson, N. O., Gupta, S., & Cao, Y. (2023). Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. Journal of the National Cancer Institute, 115(8), 909–916. https://doi.org/10.1093/jnci/djad068

Hossain, M. S., Karuniawati, H., Jairoun, A. A., Urbi, Z., Ooi, D. J., John, A., Lim, Y. C., Kibria, K. M. K., Mohiuddin, A. K. M., Ming, L. C., Goh, K. W., & Hadi, M. A. (2022). Colorectal cancer: A review of carcinogenesis, global epidemiology, current challenges, risk factors, preventive and treatment strategies. Cancers, 14(7), Article 1732. https://doi.org/10.3390/cancers14071732

Lestari, B. W., McAllister, S., Hadisoemarto, P. F., Afifah, N., Jani, I. D., Murray, M., van Crevel, R., Hill, P. C., & Alisjahbana, B. (2020). Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia. The Lancet Regional Health–Western Pacific, 5.

Luo, C., Cen, S., Ding, G., & Wu, W. (2019). Mucinous colorectal adenocarcinoma: Clinical pathology and treatment options. Cancer Communications, 39, Article 13. https://doi.org/10.1186/s40880-019-0361-0

Morgan, E., Arnold, M., Gini, A., Lorenzoni, V., Cabasag, C. J., Laversanne, M., Vignat, J., Ferlay, J., Murphy, N., & Bray, F. (2023). Global burden of colorectal cancer in 2020 and 2040: Incidence and mortality estimates from GLOBOCAN. Gut, 72(2), 338–344. https://doi.org/10.1136/gutjnl-2022-327736

Nijman, G., Imran, D., Dian, S., Ganiem, A. R., Estiasari, R., Maharani, K., Yolanda, R., Supriatin, M., Alisjahbana, B., & Lestari, B. W. (2023). Tuberculous meningitis patient pathways and delays to diagnosis in Indonesia: a retrospective cohort study. BMJ Public Health, 1(1).

Pasaribu, Y. M., Lubis, R. A. S., Shane, F., & Simanjuntak, L. T. (2025). Sociocultural Determinants of Clinical Autopsy Refusal and Their Medicolegal Impact on Diagnostic Accuracy in Indonesian Tertiary Hospitals: A Retrospective Cohort Study. Sriwijaya Journal of Forensic and Medicolegal, 3(2), 73–88.

Patel, S. G., Karlitz, J. J., Yen, T., Lieu, C. H., & Boland, C. R. (2022). The rising tide of early-onset colorectal cancer: A comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. The Lancet Gastroenterology & Hepatology, 7(3), 262–274. https://doi.org/10.1016/S2468-1253(21)00426-X

Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer statistics, 2024. CA: A Cancer Journal for Clinicians, 74(1), 12–49. https://doi.org/10.3322/caac.21820

Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A., & Jemal, A. (2023). Colorectal cancer statistics, 2023. CA: A Cancer Journal for Clinicians, 73(3), 233–254. https://doi.org/10.3322/caac.21772

Sinicrope, F. A. (2022). Increasing incidence of early-onset colorectal cancer. New England Journal of Medicine, 386(16), 1547–1558. https://doi.org/10.1056/NEJMra2200869

Spaander, M. C. W., Zauber, A. G., Syngal, S., Blaser, M. J., Sung, J. J., You, Y. N., & Kuipers, E. J. (2023). Young-onset colorectal cancer. Nature Reviews Disease Primers, 9, Article 21. https://doi.org/10.1038/s41572-023-00432-7

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660

Torres, J. A. S., Thomas, G., & Van Dellen, J. (2026). Psoas Abscess: A Possible Missed Diagnosis in the Emergency Department. Cureus, 18(1).

Xi, Y., & Xu, P. (2021). Global colorectal cancer burden in 2020 and projections to 2040. Translational Oncology, 14(10), Article 101174. https://doi.org/10.1016/j.tranon.2021.101174

Xu, B. Y., Vasanwala, F. F., & Low, S. G. (2019). A case report of an atypical presentation of pyogenic iliopsoas abscess. BMC Infectious Diseases, 19(1), 58.

Zhou, J., Wan, S., Li, C., Ding, Z., Qian, Q., Yu, H., & Li, D. (2023). Retroperitoneal abscess as a presentation of colon cancer: The largest case set analysis to date, which extracted from our unit and the literature. Frontiers in Oncology, 13, 1198592.