An Unusual Complication of Metastatic Colorectal Cancer: Port-Site Hematoma as the First Sign of Bone Marrow Involvement and Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is a life-threatening condition marked by a spectrum of thrombosis due to activation of procoagulant factors and bleeding due to eventual consumption of these factors. DIC invariably occurs secondary to an underlying condition, including infection, inflammatory conditions, trauma, and malignancies. Treatment of DIC primarily involves treatment of the underlying cause.1 Bone marrow invasion occurs when tumor cells infiltrate the hematopoietic marrow space, displacing progenitor cells and causing cytopenias. This process is distinct from bone metastases, where malignant cells spread to the cortical or trabecular bone, typically causing bone pain, pathologic fractures, or hypercalcemia. Disseminated carcinomatosis of the bone marrow (DCBM) is a particularly severe form of marrow involvement, characterized by widespread and uniform infiltration that can result in profound cytopenias, marrow failure, and DIC.2,3 Cancers most commonly associated with bone marrow invasion include prostate, lung, breast, and gastric malignancies. While gastric cancer rarely metastasizes to bone, it is frequently cited as a malignancy associated with marrow infiltration. In contrast, metastatic colorectal cancer rarely presents with DCBM leading to DIC.4,5 We present a case of a patient with metastatic colon cancer who developed acute anemia due to a large port-site hematoma. Further investigation revealed DCBM, rising carcinoembryonic antigen (CEA) levels, and DIC. In this case report, we outline the clinical course and management of this patient. Additionally, we review published cases of this rare pathology, providing insights into its presentation and clinical implications.