Presentation
Abdominal pain, distension and vomiting. Surgery for rectal carcinoma with liver metastasis 9 months ago.
Patient Data
There are distended jejunal and proximal ileal loops and a small bowel obstruction with a transition point at the level of the subumbilical region is seen. Multiple enhancing masses of the abdominal wall are seen extending along the midline scar and infiltrating the adjacent ileal loops. The distal ileal loops show segmental dilatation interspersed with stenosis. The colon is collapsed. There is a soft tissue mass of the left abdominal wall at the previous colostomy site.
The liver shows small hypodensities in segments IVb and V and a biliary cyst in segment IVa.
Multiple peritoneal and mesenteric nodules encasing the ileal loops as well as nodular omental thickening with mild intraperitoneal effusion is seen.
A soft tissue mass is noted in the left ovary. Small mesorectal lymph nodes noted. A recto-vaginal fistula is also noted.
Case Discussion
Around 25% of patients with gastrointestinal cancer will develop peritoneal carcinomatosis. Bowel obstruction is also a common complication of gastrointestinal cancer. The treatment of an intestinal obstruction in a patient with peritoneal carcinomatosis includes decompression with a nasogastric tube, intravenous fluids and sometimes operative management.
Cutaneous and subcutaneous metastases may come from haematogenous or lymphatic spread or may result from seeding from a surgical procedure (as is most likely in this case).
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