COLORECTAL CARCINOMA: A CASE OF MALIGNANT FISTULA FORMATION PRESENTING AS SEPTIC SHOCK

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Colorectal carcinoma (CRC) is the third most common cause of malignancy in United States. Common signs and symptoms include hematochezia, melena, abdominal pain, anemia, change bowel habits. Rarely, CRC can present with fistula formation subsequent infection. Here we highlight a patient known who presented intrapulmonary abscesses due to colopleural formation. CASE PRESENTATION: A 57-year-old male recently diagnosed stage IV colon adenocarcinoma presents productive cough brown, foul-smelling sputum left-sided chest pain for three weeks. Vitals showed tachycardia hypotension. Exam revealed diminished breath sounds left hemithorax tenderness palpation wall upper quadrant. Labs were significant anemia 6.2 g/dL, leukocytosis 21.3 thou/cmm bandemia 17%, peak lactate 20.1 mmol/L. Computed tomography (CT) chest, abdomen, pelvis large gas containing mass within lower lobe contiguous splenic flexure as well left-side extensive soft tissue concerning pleurocutaneous fistula. These findings consistent extension his mass. Patient was fluid resuscitated, transfused one unit packed red blood cells, started on vasopressors broad-spectrum antibiotics. Multidisciplinary discussions determined that would require surgical debridement source control; however, overall prognosis remained poor given advanced state cancer performance status. goals care discussion held declined surgery opted pursue hospice care. DISCUSSION: Colopleural an extremely rare complication potential manifest serious pulmonary infections arising perforation or invasion nearby tissue. Our developed necrotizing fasciitis Management involves multidisciplinary approach ultimately, requires emergent intervention. Unfortunately, this not always possible our too far disease course making him candidate. CONCLUSIONS: Malignant fistulas associated life-threatening infections, which medical management. It important all patients undergo age-appropriate screening close follow-up prevent such dire complications. REFERENCE #1: Lian R, Zhang G, G. Empyema caused by fistula: case report. Medicine (Baltimore). 2017 Sep;96(39):e8165. doi: 10.1097/MD.0000000000008165. PMID: 28953667; PMCID: PMC5626310. #2: Papagiannopoulos K, Gialvalis D, Dodo I, Darby MJ. resulting from true complicating perforated sigmoid diverticulum. Ann Thorac Surg. 2004 Jan;77(1):324-6. 10.1016/s0003-4975(03)01378-x. 14726092. #3: Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA J Clin. 2021 Jan;71(1):7-33. 10.3322/caac.21654. Epub Jan 12. 33433946. DISCLOSURES: No relevant relationships Arjan Ahluwalia, source=Web Response Henry Lam, Kaitlyn Musco, Andres Zirlinger,