Splenic Flexure Colon Cancer Presenting as a Perisplenic Abscess With Subsequent Intrasplenic Abscess Formation and Portal Venous Gas: A Case Report.

Splenic abscess associated with colon cancer is rare, and progression from a perisplenic abscess to an intrasplenic abscess is particularly unusual. We report the case of a 70-year-old man who presented in February 2023 with abdominal pain and fever. Contrast-enhanced computed tomography showed a perisplenic abscess and wall thickening at the splenic flexure. After percutaneous drainage and antibiotic therapy, an intrasplenic abscess and portal venous gas developed. Following infection control, colonoscopy and biopsy confirmed splenic flexure colon adenocarcinoma, and elective open left hemicolectomy with distal pancreatectomy and splenectomy was performed. Gross and histopathological examination showed no direct tumor invasion into the splenic parenchyma. This case is worth documenting because it illustrates an unusual pattern of splenic abscess progression in colon cancer and highlights the importance of considering an underlying colorectal malignancy in patients presenting with localized inflammatory abscesses around the spleen.