Advanced rectal carcinoma usually presents with rectal bleeding, tenesmus or alteration in bowel habits. Secondary deposits in the inguinal lymphnode is generally an indication of advanced disease. We report unusual presentation of advanced rectal carcinoma in a 23 year-old female patient who came presenting with symptoms of left inguinal lymphadenopathy and left leg swelling. There were no symptoms related to local effects of rectal carcinoma. First the patient was treated as a case of deep venous thrombosis. Fine needle aspiration biopsy provided the first clue to the nature of disease. To the best of our knowledge such unusual presentation of advanced rectal carcinoma has never been reported in Ethiopia. Rectal carcinoma should be considered in the list of secondary adenocarcinoma in the inguinal lymphnodes.
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