Case Report: splenic abscess as a rare complication of perforated splenic flexure colorectal carcinoma: the role of imaging and multidisciplinary management

Background Splenic abscess is an exceedingly rare complication of colorectal carcinoma, particularly when associated with tumor perforation, colosplenic fistula, and multiorgan invasion. Case presentation We present the case of a 71-year-old male patient with splenic flexure colorectal carcinoma (CRC) complicated by colosplenic fistula, splenic abscess, and invasion of the spleen, pancreas, and gastric wall, which were identified by contrast-enhanced computed tomography (CT). Following multidisciplinary team (MDT) consultation, an emergency laparotomy with multiorgan en bloc resection (left hemicolectomy, splenectomy, partial gastrectomy, distal pancreatectomy) achieved complete tumor removal. Conclusions A novel “Dual-Pathway” Hypothesis is proposed to explain CRC-associated splenic abscess pathogenesis. A structured diagnostic and treatment workflow is presented to guide future management of such complex cases. This report highlights the critical roles of advanced imaging and MDT collaboration in optimizing outcomes for rare CRC complications.