Presentation
Diffuse abdominal pain, repeated vomiting, and chronic constipation
Patient Data
Fair colonic opacification achieved after contrast enema administration showing significant short segmental concentric soft tissue mass/ thickening is seen involving the splenic colonic flexure encroaching upon its lumen, additionally, the CT images clearly illustrate the pericolic smudging as well the enlarged peri-colic lymph nodes
Subsequently, significant proximal bowel loops dilatation with partial intestinal obstruction.
Concentric constriction of splenic flexure with apple core appearance
Underwent surgical excision (partial colectomy) which was histologically proven to be colonic adenocarcinoma.
Intraoperative photos are courtesy of Dr Adel Abdelwahed (oncosurgery consultant)
Case Discussion
The apple core sign, also known as a napkin ring sign, is most frequently associated with constriction of the lumen of the colon by a stenosing annular colonic carcinoma due to bowel wall thickening with resultant circumferential constriction of the lumen.
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