Frontal sinus osteomyelitis due to orbital metastasis of colorectal adenocarcinoma: A double surgical emergency

Abstract text (incl. references and figure legends)

Case History

75 y/o women, with medical history of DM type 2, hypertension and preseptal right cellulitis treated with oral antibiotics with poor clinical response. A head CT is preformed in the ED in which osteomyelitis of the greater wing of the sphenoid bone and subperiosteal abscess of the orbit are observed. Combined orbital and endoscopic transnasal approach was preformed by the ORL team and samples were sent for pathological examination. On the 10th postoperative period, the patient presented gastrointestinal obstructive symptoms.

Clinical findings

Abdominal distention and tympanic to percussion and vomiting, suggested an intestinal obstructive syndrome

Investigation

An urgent abdominal CT was preformed.

Diagnosis

Focal stenosing descending colon neoplasia and a 10 cm cecum, with competent ileocecal valve.

Pathology samples from de the ORL surgery confirm adenocarcinoma infiltration

Therapy

A subtotal colectomy with ileosigmoid anastomosis was performed. Blood test and biochemical analysis (amylase and bilirubin levels) of the intraabdominal drainage were preformed at fist, third and fifth postoperative days with normal results. Persistence of orbital infection required consultation of the ORL team during hospital stay. The patent was discharged at the 12 postoperative day.

Comments

Colorectal cancer is the second cause of death due to cancer in our county. Approximately, 20% of all colorectal cancer have metastasis at diagnosis. Orbital metastasis are an extremely rare metastasis site for colorectal adenocarcinoma presentation and only few cases are reported in literature. Due to the obstructive behavior of the tumor of our patient, an emergency subtotal colectomy was necessary with excellent postoperative recovery and early chemotherapy and radiotherapy treatment.

References

Biller, Leah H, 2021, Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review, JAMA

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