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Perforated, malignant large bowel obstruction due to cecal distension and venous ischemia

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Abdominal pain and distension. Nil passage of flatus, ? bowel obstruction

Patient Data

Age: 90 years
Gender: Male

Distension of the colon to the sigmoid with abrupt transition to collapsed rectum. Irregular mass in the sigmoid is probably cancer although a diverticular stricture is possible. Gross cecal dilatation with swollen irregular, gas-filled mucosa is compatible with ischemia (probably venous due to luminal distension) and free gas indicating perforation, although the site of perforation is not identified.

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