Large bowel obstruction

Case contributed by Varun Babu
Diagnosis certain


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

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. 


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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