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 caliber giving the appearance of apple core, associated with loaded and mildly dilated proximal large bowel.
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 caliber 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 visualize subtle abnormal wall thickening, however many tumors present in the locally advanced stage with obstructive circumferential wall thickening, as in this case.
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