Presentation
Fall from standing. Left lower extremity is mottled, cold, and hemiparetic. Tenderness at L5.
Patient Data
There is dilatation of the large bowel within the descending colon with apparent transition point within the sigmoid colon. There is circumferential wall thickening, with irregular mural enhancement, highly concerning for obstructing colon tumor. Just distal to the lesion, there is an air-fluid collection, likely representing contained perforation/abscess. This collection lies between the inferior margin of the sigmoid tumor and the posterior margin of the uterine body. The sigmoid colon and rectum beyond the sigmoid colon mass is decompressed.
A rectal tube was placed within the rectum under fluoroscopic observation. Water-soluble contrast was administered and the colon was opacified from the rectum to the ascending colon. There is demonstration of an apple core lesion within the sigmoid colon which correlated to the masslike structure seen on the prior CT.
No contrast extravasation or fistula was identified.
Case Discussion
This is an apple core lesion as seen in colon cancer. The patient underwent colonoscopy and biopsy which revealed colon cancer.
Co-author:
Christine Cooley, MD
Peter Kim, MD