Transverse colon adenocarcinoma mimicking complicated diverticulitis with abscess: a case report and review of literature

Talal M. Alsofyani; Raghad K. Alsherbi; Hanan S. Althobaiti; Fahad M. Alhemaidi

doi:10.18203/2349-2902.isj20262473

Authors

Talal M. Alsofyani Department of Surgery, King Abdulaziz Speciality Hospital, Taif, KSA
Raghad K. Alsherbi King Abdulaziz Speciality Hospital, Taif, KSA
Hanan S. Althobaiti King Abdulaziz Speciality Hospital, Taif, KSA
Fahad M. Alhemaidi Taif University, Taif, KSA

DOI:

https://doi.org/10.18203/2349-2902.isj20262473

Keywords:

Colon cancer, Diverticulitis, Intra-abdominal abscess, Percutaneous drainage, Subtotal colectomy

Abstract

Colorectal cancer (CRC) is one of the most common cancers leading to death and illness globally. In cases of complicated diverticulitis with abscess, the usual course of action is to manage the condition with antibiotics and drainage. However, Inflammatory diverticular disease may have a similar clinical and imaging presentation to CRC, leading to a diagnostic dilemma. This study presents a case of a 68-year-old male with acute abdominal pain and a non-contrast computed tomography (CT) scan showed distal transverse colon diverticulitis with a 6.1×6.5 cm abscess. He was treated with IV antibiotics and IR-guided percutaneous drainage, but developed a persistent purulent discharge at the drain site, followed by hematochezia. A contrast-enhanced CT scan showed persistent thickening of the colonic wall and a track from the collection to the skin. A subtotal colectomy with loop ileostomy was done. The histopathology showed a perforated, moderately differentiated transverse colon adenocarcinoma (pT4aN0M0; stage IIB). To conclude, the lack of improvement after drainage or the development of a tract/fistula should trigger an urgent reassessment for an occult malignancy and control of the source.

References

Zhang T, Guo Y, Qiu B, Dai X, Wang Y, Cao X. Global, regional, and national trends in colorectal cancer burden from 1990 to 2021 and projections to 2040. Front Oncol. 2024;14:1466159.

Heisser T, Sergeev D, Hoffmeister M, Brenner H. Contributions of early detection and cancer prevention to colorectal cancer mortality reduction by screening colonoscopy: a validated modeling study. Gastrointest Endosc. 2024;100:710-7.

Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020;15:32.

Siewert B, Tye G, Kruskal J, Sosna J, Opelka F, Raptopoulos V, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006;186:680-6.

Simsar M, Yuruk YY, Sahin O, Sahin H. Radiological insights into diverticulitis: Clinical manifestations, complications, and differential diagnosis. World J Radiol. 2025;17:107463.

Meyer J, Orci LA, Combescure C, Balaphas A, Morel P, Buchs NC, et al. Risk of Colorectal Cancer in Patients With Acute Diverticulitis: A Systematic Review and Meta-analysis of Observational Studies. Clin Gastroenterol Hepatol. 2019;17:1448-56.

Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020;63:728-47.

Cirocchi R, Duro F, Avenia S, Capitoli M, Tebala GD, Allegritti M, et al. Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review. J Clin Med. 2023;12:5522.

Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography. Abdom Imaging. 2012;37:1101-9.

Yang KM, Jeong MJ, Yoon KH, Jung YT, Kwak JY. Oncologic outcome of colon cancer with perforation and obstruction. BMC Gastroenterol. 2022;22:247.

Baxter NN, Kennedy EB, Bergsland E, Berlin J, George TJ, Gill S, et al. Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update. J Clin Oncol. 2022;40:892-910.

Tolley JA. Chronic diverticulitis with perforation and associated carcinoma of the cecum. Dis Colon Rectum. 1967;10:389-93.

Drut R. Adenoacanthoma arising in a diverticulum of the colon: report of a case. Dis Colon Rectum. 1974;17:258-61.

Hines JR, Gordon RT. Adenocarcinoma arising in a diverticular abscess of the colon: report of a case. Dis Colon Rectum. 1975;18:49-51.

McCraw RC, Wilson SM, Brown FM, Gardner WA. Adenocarcinoma arising in a sigmoid diverticulum: report of a case. Dis Colon Rectum. 1976;19:553-6.

Prescott RJ, Haboubi NY, Dunaway DJ, Kiff ES. Carcinoma arising in a diverticulum of sigmoid colon. Histopathology. 1992;21:387-9.

Kajiwara H, Umemura S, Mukai M, Sadahiro S, Tsutsumi Y. Adenocarcinoma arising within a colonic diverticulum. Pathol Int. 1996;46:538-9.

Kikuchi T, Kotanagi H, Kon H, Koyama K, Ito S, Otaka M. Mucosal carcinoma within a colonic diverticulum. J Gastroenterol. 1999;34:622-5.

Bellows CF, Haque S. Adenocarcinoma within a diverticulum: a common tumor arising in an uncommon location. Dig Dis Sci. 2002;47:2758-9.

van Beurden A, Baeten CIM, Lange CPE, Doornewaard H, Tseng LNL. Adenocarcinoma Arising within a Colonic Diverticulum in a Patient with Recurrent Diverticulitis. Clin Med Oncol. 2008;2:529-31.

Fu KI, Hamahata Y, Tsujinaka Y. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy. World J Gastroenterol. 2010;16:1545-7.

Yeo ESA, Ng KH, Eu KW. Perforated colorectal cancer: an important differential diagnosis in all presumed diverticular abscesses. Ann Acad Med Singap. 2011;40:375-8.

Merkow RP, Sun JH. Metastatic adenocarcinoma arising within a diverticulum: endoscopist’s nightmare. Am Surg. 2011;77:109-10.

Parsyan A, Cardin MJ, Hassoun H, Andalib A, Tataryn D, Meterissian S, et al. Challenging diagnosis of intra-diverticular colonic adenocarcinoma with submucosal localization. Int J Colorectal Dis. 2013;28:1735-7.

Yagi Y, Shoji Y, Sasaki S, Yoshikawa A, Tsukioka Y, Fukushima W, et al. Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature. BMC Gastroenterol. 2014;14:90.

Kayano H, Ueda Y, Machida T, Hiraiwa S, Zakoji H, Tajiri T, et al. Colon cancer arising from colonic diverticulum: A case report. World J Clin Cases. 2019;7:1643-51.

Ikebata A, Mikami S, Yoo JH, Tsuwano S, Hayatsu S. Sigmoid Colon Cancer Masked by Refractory Diverticulitis With Abscess. Cureus. 2023;15:e48326.