Presentation
Three weeks of increasing generalized abdominal pain and vomiting. Bowels not opened for three days.
Patient Data
Dilated loops of small bowel with air fluid levels. Paucity of gas within the colon, which is generally collapsed. The terminal ileum and cecum is thick walled and enhancing, with the impression of a mass. The appendix is thickened and enhancing although there is no significant periappendiceal fat stranding.
Enlarged para-aortic lymph nodes. No free gas. Trace of free fluid. Soft tissue density is is seen within the peritoneal in the right paracolic gutter.
Conclusion:
Distal mechanical small bowel obstruction with the level of obstruction being centered on the ileocecal valve. The cecum, terminal ilium and appendix are all thickened and enhancing. Enlarged para-aortic lymph nodes. Overall, appearances are suspicious for a cecal malignancy.
The patient proceeded to right hemicolectomy.
Histopathology: Sections of the lesion noted macroscopically at the ileo-cecal valve show an ulcerated, poorly differentiated, partially mucinous adenocarcinoma involving predominantly cecal mucosa and wall but also involving terminal ileum and appendix. Extensive lymph node metastases.
Case Discussion
Colorectal carcinomas that arise at the ileocecal valve are uncommon, making up only 2% of CRCs. They typically present late due to obstruction, since the contents of the ileum is liquid.
Unable to process the form. Check for errors and try again.