Crohn's colitis with malignant splenic flexure mass

Case contributed by Dr Paul Simkin

Presentation

Right sided abdominal pain in the setting of Crohn's disease.

Patient Data

Age: 35 years
Gender: Female

Pancolitis is present. There is increased enhancement of the colonic splenic flexure relative to the rest of the colon, consistent with active inflammation. There is adjacent mesenteric fat stranding and necrotic lymph nodes, with suspected microperforation/early fistula formation and possible early fistula formation with the adjacent jejunum.

Given the marked wall thickening seen at the splenic flexure correlation with CT enterography in 4-6 weeks or colonoscopy is suggested (to exclude underlying malignancy).

Pancolitis is again demonstrated. There is more irregular bowel wall thickening involving the splenic flexure, and proximal descending colon as shown on the recent MR. No evidence of a focal colonic mass elsewhere. 

Case Discussion

Surgical pathology results

DIAGNOSIS:

  1. Terminal ileum biopsy: Mild active chronic ileitis
  2. 30 cm biopsy & 40 cm biopsy: Undifferentiated malignant neoplasm.
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Case information

rID: 51633
Published: 8th Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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