Large bowel obstruction

Case contributed by Dr Varun Babu

Presentation

Abdominal pain for the past 3 days. Outside evaluation revealed doubtful renal calculi and was given symptomatic treatment. Since pain was not subsiding, she was referred to a higher center. Bilious vomiting was observed at the time of sonographic study of abdomen.

Patient Data

Age: 40 years
Gender: Female
X-ray

Abdominal erect radiograph

Radiographs reveal dilated small bowel loops with multiple air fluid levels, suggestive of possible distal bowel obstruction. USG correlation revealed dilated small bowel loops and large bowel upto distal descending colon. Further evaluation with CT was warranted. 

CT

CT abdomen with oral and iv contrast

A short segment narrowing measuring 3 cm in the distal descending colon with dilatation of proximal colon with mildly enhancing wall. 

Case Discussion

Colonoscopy revealed a lumen occluding circumferential proliferative growth in the descending colon. 

Microscopic Description: Section shows fragments of large intestinal mucosa containing part of an ulcerating neoplasm with villous architecture in places lined by cells displaying nuclear crowding, stratification and hyperchromasia, variably conspicuous nucleoli and frequent mitosis. Disorganized glands with luminal necrosis and moderate to severe degree of cytological atypia and apical mitosis are present in the lamina propria and also between muscularis mucosal fibers. There is associated inflammation and desmoplasia

Colonic biopsy conclusion: Moderately differentiated colon adenocarcinoma.

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Case information

rID: 18015
Published: 31st May 2012
Last edited: 8th Mar 2020
Inclusion in quiz mode: Included

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