Presentation
Abdominal pain and distention with a three month history of weight loss
Patient Data
Age: 70 years
Gender: Male
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Findings:
- Concentric mural thickening of the descending colon extends over a length of approximately 54mm and is associated with mild adjacent inflammatory fat stranding.
- The large bowel proximally is dilated, with the transverse colon measuring up to 7.2cm in diameter. The caliber of the small bowel is prominent, measuring up to 33mm in diameter.
- There is no collection or extra-mural gas to suggest perforation.
- A small volume of free fluid is noted in the right paracolic gutter.
- Multiple hypodense focal hepatic lesions are identified, the largest of which measures 3.6cm in diameter.
- Multiple prominent para-aortic and mesenteric lymph nodes are noted in the left
side of the abdomen. - Focal colonic lesion of the descending colon is consistent with a colorectal carcinoma and is causing a large bowel obstruction.
- Nodal and hepatic metastatic disease is also demonstrated.
Conclusion:
Case Discussion
70-year-old male presented with a large bowel obstruction secondary to an obstructing descending colon 'apple core' lesion.
The patient underwent an open left hemicolectomy.
Histopathology:
- Moderately differentiated adenocarcinoma with micropapillary carcinoma component
- Pathological stage pT3 pN1b (AJCC 8th Edition; 2016)
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