Background: The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most
common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial
presentation is uncommon. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local
redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20
x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial
impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks.
She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole
abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an
exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and
she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate
preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy
pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and
prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus
on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this
differential because it is easily ignored pre-operatively.
