A fifty year old male presented with abdominal swelling in the right upper abdomen for two months. There was history of abdominal distension, with low grade abdominal pain. There was history of general body malaise. No fever was reported. No history of vomiting, no diarrhea. There was no history of melena stools. The rest of the systemic review was normal in the respiratory, genitourinary and central nervous system. Examination findings: on general exam he was anemic, no lymphadenopathy, no finger clubbing. Cardiovascular normal regular thin pulse 72/min, BP =120/80mmHg.The chest findings were normal. Abdomen right lumbar mass felt had and ill defined. No organomegaly. Diagonosis: ANAEMIA R/O CAUSE, RT LUMBAR MASS. LABORATORY: Hb=6.9g/dl,ESR 80mm hr westergreen.Urinalysis normal.Blood smear for typin the anemia was not done. ABDOMINAL SCAN showed right paraclic gutter mass measuring 6x6cm. it was echppor with ill defined margins. no free fluid. no organs. Barium Enema there was normal filling of the rectum and sigmoid colon. normal haustral patterns.There was no flow of barium past the right flexure.The ceacum doesnot fill with barium.there is narowing seen forming an annular lesion. diagonisis; Neoplastic stricture of the right colon.
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FIG1: shows a supine oblique view with barium filling the rest of the colon with minimal flow passed the right flexure.The is an annular lesion in the ascending colon.The caecum doesnot fill with barium.No haustrations are seen.
Patient was prepared for a laparotomy had a right ileostomy, confirmed carcinoma of the right colon passed on the 6 post operative day.
Colorectal carcinoma is one the leading causes of morbidity and mortality. It is the third commonest after lung, chest , and renal tumors in the elderly. The case presentation the age was slightly lower compared to what is known.The sex it is commoner in the males than females.
Clinical presentation: Right sided tumors usually present with non obstructive symptoms, as in this case.The left sided tumors present with obstruction. Anemia is common as in this case.
Imaging: On DBCE colorectal carcinomas may manifest as palquelike, polypoid, semi annular , annular or carpet lesions. Some times lesions may be missed. This case Dbce Showed an annular lesion involving the right colon.
Sonography showed a right paracolic gutter mass, the rest of the organs were normal.
Conclusion: DBCE still has a role in the diagnosis of colorectal carcinoma, were colonoscopy cannot be done.
- 1.Kelvin FM, Gardiner R, Colorectal carcinoma missed on DBCE study: A problem in perception: AJR, Am J Roentgenol 1981:137: 307-313. 2. Bp