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Large bowel obstruction - due to a colonic tumor

Case contributed by Ian Bickle
Diagnosis certain

Presentation

A young female presents with a distended abdomen and altered bowel habit.

Patient Data

Age: 25
Gender: Female

Stenosing tumor in the hepatic flexure, with foci of calcification within, resulting in a high grade large bowel obstruction.

The small bowel is also distended in keeping with an incompetent ileocecal valve.

Case Discussion

Colorectal carcinoma is one of the commonest primary tumors, occurring largely in the older patient demographic.  It can however effect those under 30 years of age, especially when associated with familial or syndromic conditions, such as familial adenomatous polyposis syndrome.

It remains the commonest cause of large bowel obstruction.  In some patients, who typically present later, the ileocecal valve may be incompetent resulting in an associated small bowel obstruction (it 'deflates' itself into the small bowel first so 'buying' time before overwhelming symptoms for the patient).

This patients histology identified a mucinous adenocarcinoma. This histological subtype will often contain calcification in both the primary and distant metastases.

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