Delayed abdominal wall abscess after abdomino-perineal resection simulating local recurrence of rectal cancer

Abstract

IntroductionWe report a rare case of delayed abdominal wall abscess after abdominoperineal resection (APR) for rectal cancer.Case descriptionA 63-year-old woman was diagnosed with rectal cancer and received chemo-radiotherapy, followed by APR. One year after surgery, the patient complained of pain and skin redness in the lower abdomen. A low-density mass lesion with 5.9-cm diameter was found in the lower abdominal wall by computed tomography, which showed high uptake on positron-emission tomography. These findings suggested the possibilities of either delayed abscess formation or abdominal wall recurrence of rectal cancer with central necrosis. Percutaneous drainage was performed. The content was a purulent exudate, without neoplastic cells in the cytology. The lesion quickly disappeared after the drainage, and no recurrence of the tumor was observed for more than 2 years.Discussion and evaluationIn this case, the un-absorbable yarn, such as silk, has not been used during the operation, no foreign body was retained in the abdominal wall, and there was no associated inflammatory bowel disease. Use of neoadjuvant chemoradiotherapy was the only possible cause of delayed abscess formation in this case.ConclusionIn case local recurrence is suspected by imaging modalities in the postoperative of colorectal cancer, especially those with precedent chemoradiotherapy or radiotherapy, although rare, the possibility of a delayed abscess formation should also be considered.

Intraabdominal abscess mimicking gastric cancer recurrence: a case report

“…The pathological result of the resected mass lesion revealed acute and chronic inflammation with abscess formation and fibrosis. As previously mentioned, most SSIs occur within 30 days of surgery; however, in rare cases, SSIs can occur even several months after surgery [ 1 ]. In some cases, an abscess can be misdiagnosed as a tumor, as in this case [ 2 - 4 ].…”

“…If an SSI occurs, early diagnosis and treatment are important. SSI occurs mostly within 30 days after surgery, but it can also rarely occur several months after surgery [ 1 ].…”

Aseptic abscess in the abdominal wall accompanied by monoclonal gammopathy simulating the local recurrence of rectal cancer: A case report

“…Infectious abscesses in the abdominal wall can be secondary to retained foreign bodies ( e.g., stones, use of artificial mesh, use of silk yarn in surgical suture)[ 1 ], inflammatory diseases ( e.g ., acute appendicitis[ 2 ]), and perforated malignancies of the digestive tract (particularly in the colon)[ 3 ]. Patients often present with a painful anterior abdominal wall mass, sometimes with purulent discharge and systemic symptoms ( e.g., fever)[ 2 ].…”