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Perforated hepatic flexure adenocarcinoma mimicking pyogenic hepatic abscess: A CT diagnostic pitfall

Year: 2026

Type: article

Abstract: Perforated colorectal carcinoma may present with inflammatory and septic features that obscure the underlying malignancy. Tumors arising at the hepatic flexure are particularly challenging because of their close anatomical relationship with the liver, allowing perforation-related inflammation and necrotic hepatic metastases to mimic pyogenic hepatic abscesses on imaging. A 58-year-old man with hypertension and human immunodeficiency virus (HIV) infection receiving antiretroviral therapy presented with acute abdominal pain, fever, chills, and systemic inflammatory symptoms. Ultrasound demonstrated hepatic lesions and irregular hepatic flexure wall thickening suspicious for malignancy, while contrast-enhanced CT showed multiple abscess-like hepatic lesions with features of both metastatic disease and perforation-related inflammation. Emergency laparotomy revealed a perforated hepatic flexure tumor densely adherent to the liver, with fibrinopurulent exudate, an inflammatory tract between the hepatic flexure and adjacent liver, multiple hepatic nodules, and peritoneal tumor seeding; histopathology confirmed moderately differentiated adenocarcinoma with hepatic and nodal metastases and central necrosis in the hepatic lesions (pT4N2M1). This case highlights the diagnostic overlap between pyogenic hepatic abscesses and necrotic hepatic metastases associated with perforated colorectal carcinoma. When abscess-like hepatic lesions coexist with irregular colonic wall thickening, regional lymphadenopathy, or loss of normal tissue planes, colorectal malignancy should remain an important consideration despite accompanying inflammatory features.

Source: Radiology Case Reports

DOI: 10.1016/j.radcr.2026.10.032

Authors: Getnet Bimer Kelemu, Dress Enyew Mhret, Yeshiambel Gete Tsegaw, Shimalis Fayisa

Institutions: Samara University, Bahir Dar University

Language: English

Topic: Colorectal Cancer Surgical Treatments

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $600