Presentation
Constipation and abdominal pain
Patient Data
There is an area of abnormal wall thickening and enhancement seen in the descending colon with surrounding fat stranding, causing shouldering and abrupt change in luminal calibre giving the appearance of apple core, associated with loaded and mildly dilated proximal large bowel.
Mesocolic margin (Colonic tumours): None.
Other pathology: Diverticulitis.
Pathological staging, Modified Dukes ( Astler - Coller ) : B2.
pTNM staging: pT3N0.
Further comments:
- The tumour shows more than 50% mucinous morphology.
- The omentum shows no evidence of malignancy.
DIAGNOSIS:
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Descending colon, moderately differentiated mucinous carcinoma, pT3N0.
End of Reprot
Case Discussion
Colorectal cancer is a common malignancy that can present with pain or obstructive symptoms. The appearance may resemble diverticulitis when the pericolic fat is infiltrated and careful assessment of the luminal calibre and wall thickness and enhancement is essential in differentiating the two entities.
This patient has been on treatment for constipation predominant irritable bowel syndrome and came to the emergency department with new onset vague abdominal pain.
Sufficient colonic distension with rectal gas can be required to visualise subtle abnormal wall thickening, however many tumours present in the locally advanced stage with obstructive circumferential wall thickening, as in this case.
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