A Case of Persistent Diarrhea and Fevers Uncovering Colorectal Adenocarcinoma

TL;DR

A man with unexplained GI symptoms and a family history of cancer was diagnosed with colorectal cancer, emphasizing the need for early screening.

Contribution

Highlights an atypical presentation of colorectal cancer with left upper quadrant pain and absence of rectal bleeding.

Findings

The patient presented with chronic abdominal pain, diarrhea, and weight loss, leading to diagnosis of colorectal adenocarcinoma.

The tumor was located in the splenic flexure with extramural extension, and the patient had no prior cancer screening.

This case underscores the importance of considering colorectal cancer in patients with persistent GI symptoms, even with atypical signs.

Abstract

Colorectal cancer (CRC) is a major contributor to cancer-related mortality in the United States and remains a substantial public health challenge worldwide. Although screening modalities have proven efficacy in reducing both incidence and mortality, adherence to these preventive measures is still suboptimal. We present a Hispanic man in his early 50s with no prior screening who developed CRC.

Our patient presented to the emergency department with a one-month history of chronic left upper quadrant abdominal pain, diarrhea, unintentional weight loss, decreased appetite, intermittent fevers, and an extensive history of cancer in his family. Investigations revealed a large, partially obstructive mass in the splenic flexure with extramural extension. He underwent an extended left colectomy with partial gastrectomy and loop ileostomy. Pathology confirmed low-grade colorectal adenocarcinoma. He reports no regular medical care and no prior esophagogastroduodenoscopy or colonoscopy.

This case demonstrates an atypical presentation with left upper quadrant pain relating to splenic flexure involvement and the absence of rectal bleeding. It highlights the need to maintain a high index of suspicion for colorectal malignancy in patients with persistent or unexplained GI symptoms, even when the clinical presentation is atypical or localizes outside the expected distribution.

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