Presentation
3 days of increasing abdominal distension and not opening bowels. Iron deficiency anemia.
Patient Data
Irregular thickening of the wall of the colon is seen at the splenic flexure with adjacent nodular soft tissue. The colon distal to this is collapsed but proximally is markedly distended. In particular, the cecum is very distended. A small volume of free fluid is seen. There are bubbles of gas seen between the colon wall and luminal content, particularly in the cecum and ascending colon. No suspicious liver lesions.
Case Discussion
The splenic flexure lesion is causing large bowel obstruction. The distribution and appearance of the gas in the cecum and ascending colon is not entirely typical of pneumatosis, particularly as it is not definitely circumferential, and may simply be due to gas trapped between the luminal stool content and the colonic mucosa. Nonetheless the differential is the presence of mucosal gas which may be indicate developing proximal colonic ischemia and should be communicated to the referring clinician. An extended right hemicolectomy confirmed an adenocarcinoma of the splenic flexure but no perforation.
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