A 73-year-old woman ultimately proven to have perforated colorectal adenocarcinoma presented to the emergency department with cellulitis of the abdominal wall. This case illustrates the challenge of diagnosis and management of such patients. It demonstrates limitations of colonoscopy and the importance of computed tomography to diagnose and characterize the disease. The optimal strategy for percutaneous abscess drainage and the utility of pre-operative radiation therapy for such rare presentations of colon cancer are discussed. Favorable outcomes are achieved despite the locally-invasive colon cancer.