Delayed Cervical and Multifocal Spinal Metastases From Rectal Adenocarcinoma: A Case Report of Severe Canal Stenosis, Neurological Decline, and Septic Shock.

A 76-year-old male with a past medical history significant for rectal adenocarcinoma diagnosed in 2014 presented to the emergency department with worsening left arm pain, generalized weakness, and two syncopal episodes. The patient previously underwent sigmoid colectomy followed by low anterior resection and permanent colostomy. Imaging revealed diffuse spinal metastases with extensive epidural tumor causing multilevel severe canal stenosis and spinal cord compression. Additional findings included hepatic metastases, bilateral pleural effusions, supraclavicular nodal disease, and suspected leptomeningeal involvement. This case highlights the rare but devastating pattern of colorectal cancer metastasis to the spine and underscores the importance of early recognition of metastatic epidural disease, multidisciplinary management coordination, palliative care integration.