Malignant large bowel obstruction
Abdominal distension and colicky pain for one week. Right inguinal hernia. Vague left sided mass. Obstruction?
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No intravenous (IV) contrast and paucity of intraabdominal 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 upto 1.5cm.
Bilateral hydronephrosis due to bladder prolapse.
Comment: Large bowel obstruction due to descending colon tumor
The patient proceeded to a 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 absent 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.
Gross specimen: 20cm length of tumor, with ulceration and extra-serosal extension.
H & E: Moderately differentiated adenocarcinoma of the colon