Methods
For a clearer diagnosis, laboratory tests were conducted, and the results indicated an elevated white blood cell count at 14 × 10^3 per L, with the normal range being 4.0–10.8 × 10^3 per L. This elevation was primarily due to neutrophilia. Furthermore, her hemoglobin level was slightly low at 11 mg/dL, compared to the typical range of 12–16 g/dL. Her albumin level was also below the normal, registering at 3.1 g/dL, where the standard range is between 3.4 and 4.8 g/dL.
Imaging examinations provided further insights into her condition. A CT scan displayed a substantial mass originating from the caecum and extending to the transverse colon as shown in Figure 2 . This mass measured 13x10x13 cm and had multiple air locules noted along the posterior lateral wall of the ascending colon mass. This mass extended towards the hepatic flexure and opened into the subcutaneous plane. A colonoscopy further revealed a large ulcerated growth in the transverse colon, causing a narrowing of the lumen. This made it difficult for the scope to be advanced proximally. A biopsy of this growth confirmed the diagnosis of adenocarcinoma of the colon
Expert opinion was taken and the patient was planned for an exploratory laparotomy with extended right hemi colectomy and en bloc resection as shown in Figure 3 . Biopsy showed poorly differentiated mucinous adenocarcinoma, tumor extended beyond muscularis propia and perforated serosa with positive lymph node findings. Post operatively patient was sent to oncology for chemotherapy.