Presentation
Short history of abdominal distension. No motion passed for 2 days. Large bowel obstruction?
Patient Data
The large bowel is grossly dilated down to the level of a cut-off at the junction of the distal descending and sigmoid colon.
The small bowel is moderately dilated.
Non contrast due to renal impairment.
4.5cm stenosing tumor at the junction of the sigmoid and descending colon with resultant dilatation of the large bowel upto 9cm. Blebs of intramural gas throughout the colon.
The distal small bowel is dilated due to a incompetent ileocecal valve.
Multiple foci of pneumoperitoneum in the mid and upper abdomen.
No overt infradiaphrgamatic nodes.
At least two right lower lobe lung nodules, the largest 8mm.
The apple core stricture (blue arrows) of the short stenosing malignant stricture from the tumor with shouldered edges (red arrow) clearly outlined.
The operative findings from the laparotomy that followed the CT abdomen.
Case Discussion
The not so uncommon acute presentation of a colorectal malignancy with a large bowel obstruction.
A small proportion will have perforated at the time of the presentation as in this case.
The short stenosing tumor in the sagittal images has the an 'apple core' appearance classically observed in barium enema studies.
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