title: Splenic abscess owing to cancer at the splenic flexure: A case report and comprehensive review.
abstract: BACKGROUND
  The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset.
  
  
  METHODS
  We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction.
  
  
  RESULTS
  An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a Coloplast Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess.
  
  
  CONCLUSIONS
  This is the 13 case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear.
authors.affiliation: Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China The First Affiliated Hospital Collaborative Innovation Center of Oncology-Institute of Cancer Stem Cell, Dalian Medical University, Dalian City, Liaoning Province, P.R. China.
authors.forename: Gavish K
authors.initials: GK
authors.lastname: Awotar
authors.forename: Fuwen
authors.initials: F
authors.lastname: Luo
authors.forename: Zhengdong
authors.initials: Z
authors.lastname: Zhao
authors.forename: Guoxin
authors.initials: G
authors.lastname: Guan
authors.forename: Shili
authors.initials: S
authors.lastname: Ning
authors.forename: Jinshuai
authors.initials: J
authors.lastname: Ren
authors.forename: Yaqing
authors.initials: Y
authors.lastname: Liu
authors.forename: Guangzhi
authors.initials: G
authors.lastname: Wang
authors.forename: Pixu
authors.initials: P
authors.lastname: Liu
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery; D016154:Digestive System Fistula / Q000209:etiology / Q000601:surgery; D004322:Drainage / Q000379:methods; D016972:Enterobacter cloacae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000473:pathology; D013158:Splenic Diseases / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D014057:Tomography, X-Ray Computed