Presentation
Abdominal distension and colicky pain for one week. Right inguinal hernia. Vague left sided mass. Obstruction?
Patient Data
No intravenous (IV) contrast and paucity of intra-abdominal fat.
9cm segment of circumfrentially thickened mid descending colon. The proximal large bowel is dilated. Collapsed small bowel.
Right inguinal hernia containing small bowel.
Multiple pericolic nodes adjacent to the thickened colon up to 1.5 cm.
Bilateral hydronephrosis due to chronic bladder outlet obstruction by the enlarged prostate, suggestive of bilateral secondary vesicoureteric reflux disease.
Hepatomegaly.
Comment: Large bowel obstruction due to descending colon tumor.
Case Discussion
The patient proceeded to laparotomy for the acute issue of bowel obstruction.
This case demonstrates that a good deal of critical information can be identified without intravenous contrast. However, bear in mind that the radiologist is uniquely expert in assisting in the complete care of the patient by communicating the study limitations.
For example, given the absence of IV contrast, solid organ metastases are difficult to exclude. Similarly, in due course, complete staging of the chest will be required. It is often worth adding something to this effect in the report, like, 'Consider ultrasound abdomen (in due course) for solid organ metastases assessment and staging CT chest' at the report summary.
This case is to add to the Non-Contrast CT Abdomen playlist to enthuse readers of the potential to confidently identify key pathology when no IV contrast can be administered.
HISTOLOGY
Gross specimen: 20cm length of tumor, with ulceration and extra-serosal extension.
H & E: Moderately differentiated adenocarcinoma of the colon
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