Presentation
Five days history of abdominal pain, distension, and failure of passage of flatus and stool.
Patient Data
Distended fluid-filled large bowel and distal ileal loops with an irregular circumferential thickening at the rectosigmoid junction with luminal narrowing, infiltration of the perirectosigmoid fat and presence of regional enlarged lymph nodes. There is a small air collection with peripheral enhancement adjacent to the rectosigmoid stricture suggestive a focal perforation (less likely to be sigmoid diverticulum).
Focal fatty infiltration of the segment IVa of the liver is noted (confirmed by ultrasound).
Case Discussion
CT features are suggestive of an obstructing rectosigmoid tumor with most likely focal perforation.
Large bowel obstructions are less common than small bowel obstruction. It is considered an emergency condition that requires early diagnosis and intervention. The dilatation of the colon increases the risk of perforation which usually occurs at the site of obstruction or more proximal due to ischemic changes. The most common etiology in adulthood remains colon cancer, typically of sigmoid location.
Additional contributor: Djamel Hamidi, MD EPH Ouargla, Algeria.
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