Large bowel obstruction secondary to colorectal carcinoma

Case contributed by RMH Core Conditions

Presentation

Distended abdo + PR bleed ?bowel obstruction ?ascites.

Patient Data

Age: 70 years
Gender: Male

The entire colon is dilated and gas filled with the caecum measuring up to 10 cm in maximal diameter. Multiple air fluid levels seen on the erect film. Gas filled loops of small bowel are identified.

There is marked dilation of the stomach, small bowel and large bowel with air-fluid levels. The transition point is at the rectosigmoid junction, where there is a shouldered apple core stenosing lesion.

There is a small volume of free fluid in the pelvis. No mural or portal venous gas.

Bilateral inguinal hernias contain fat and free fluid on the left, and fat and the anti-mesenteric border of a short segment of sigmoid colon on the right. Moderate hiatus hernia. Right adrenal nodule.

Modality: Annotated image
  • Red arrow = short "apple-core" colic stricture. 
  • Blue arrow = dilated large bowel proximal to stricture. 
  • Yellow arrows = dilated small bowel loops. 

HISTOPATHOLOGY

MACROSCOPIC DESCRIPTION: "Colon": A piece of oedematous, congested sigmoid colon 100mm in length. Located 5mm from the presumed distal resection margin is a circumferential, stenosing fungating tumour 30mm in length. Cross sectioning shows early invasion into mesocolic fat. The mesocolic fat contains several lymph nodes up to 8mm. There is uncomplicated diverticular disease.

MICROSCOPIC DESCRIPTION: Sections show a moderately differentiated colonic adenocarcinoma invading through the full thickness of the wall. Tumour is present in serosal adhesions and lies less than 0.1mm from the serosal surface. There is lymphovascular invasion. Eight lymph nodes were identified; three contain metastatic tumour. The tumour is at least 6mm from the distal resection margin. There is a separate severely dysplastic tubulovillous adenoma as well as uncomplicated diverticular disease.

DIAGNOSIS: Sigmoid colectomy: Moderately differentiated colonic adenocarcinoma.

Case Discussion

Classic cause and case of large bowel obstruction. Malignancy is the most common (50-60%) cause of large bowel obstructions. 

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Case Information

rID: 42708
Case created: 3rd Feb 2016
Last edited: 31st Mar 2017
Inclusion in quiz mode: Included

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