Colorectal carcinoma with bowel obstruction

Case contributed by Eugen Divjak


Constipation for the last 4 days, accompanied with periumbilical abdominal pain, dyspepsia, and vomiting. He underwent a right inguinal hernia surgery 24 years ago.

Patient Data

Age: 70 years
Gender: Male

An infiltrative tumor mass in proximal descending colon adjacent to the splenic flexure, measuring around 9.5 cm in length. Blurring of surrounding fat tissue can be observed, as well as regional lymphadenopathy, with the largest lymph nodes measuring up to 1.2 cm in short axis. The tumor mass is adjacent to middle portion of left kidney, but with no clear signs of Gerota's fascia involvement. The tumor mass is causing stenosis and lumen of the large and small intestine are consequently dilated.  The colon measures up to 6.3 cm, the cecum up to 8 cm and the small intestine up to 4.2 cm in diameter.

Gallstones can be seen in the gallbladder, which also shows mild wall thickening.

Inguinal hernia is seen on the left, containing part of urinary baldder, measuring 6 x 3.2 cm.

Case Discussion

Studies have shown differences between right- and left-sided colon carcinomas and today they are considered to be two different pathological entities. Available data even shows higher mortality rates in patients with right-sided carcinomas. Furthermore, carcinomas of the right and left colon show different geographical and demographical distribution: right colon carcinoma more commonly occurs in the elderly and in women living in regions with a low incidence of colorectal carcinoma. On the other hand, left colon carcinoma is more frequently found in male and middle-aged patients.

Regarding the inguinal hernia containing urinary bladder, it represents an uncommon finding, (1-5% of inguinal hernias). Urinary tract symptoms are usually not present. The optimal treatment method is open surgery.

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