When colon cancer crosses boundaries: acute abdomen from direct pancreatic infiltration by a splenic flexure tumour.

Colorectal cancer is the second-leading cause of cancer death in the United States. Locally advanced invasion into an adjacent organ (T4b) occurs in 10%-20% of colon cancers. A 65-year-old man presented with weakness and abdominal pain. The abdomen was soft, moderately distended, and severely tender in the epigastric region. Laboratory studies showed leukocytosis and lactic acidosis. Computed tomography of abdomen demonstrated intra-abdominal free air and splenic abscess. During emergent laparotomy, a perforated splenic flexure mass involving the pancreatic tail and spleen was identified. En bloc resection was performed with temporary abdominal closure. Following hemodynamic improvement, the abdomen was closed with creation of a transverse end colostomy. Pathology revealed moderately differentiated adenocarcinoma with transmural invasion into the pancreatic tail. Multimodal therapy is the standard approach for locally advanced colon cancer. An en-bloc resection of involved organs to achieve an R0 margin remains the cornerstone of surgical management.