BMJ Case Reports 2017; doi:10.1136/bcr-2017-220752
  • Learning from errors

Caecal cancer presenting as leg erythema and a lung opacity

  1. Peter McCullough
  1. Department of Colorectal Surgery, University Hospital Coventry, Coventry, West Midlands, UK
  1. Correspondence to Dr Archik Das, archik.das{at}
  • Accepted 25 August 2017
  • Published 7 September 2017


Necrotising infection of the lower limb is a rare presentation for colorectal malignancy. We report a case of a perforated caecal adenocarcinoma presenting with right leg erythema, pain and swelling in the presence of a right lower lobe lung opacity. Following initial debridement and washout, CT imaging demonstrated a thickened terminal ileum, caecum and appendix, in keeping with primary malignancy. This fed the right-sided lower limb sepsis tracking down from the medial aspect of the psoas muscle to give rise to the multiloculated collection seen in the adductor compartment. The lung lesion measured 16 mm and was metastatic. The patient was successfully managed with a subtotal colectomy and an end ileostomy. The biopsy confirmed an adenocarcinoma (T4N1M1). We highlight the importance of perforated colonic carcinoma as a leading differential for lower limb abscesses. Suspicions should be raised further if accompanied by rounded opacifications on plain film radiography of the lungs.


  • Handling editor Seema Biswas.

  • Contributors AD was involved in writing the case report. KH, MT and PMC all provided regular input into helping to edit and finalise the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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