Obstructing colon cancer with gas in caecal wall
3 days of increasing abdominal distension and not opening bowels. Iron deficiency anaemia.
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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 caecum is very distended. A small volume of free fluid is seen. There are bubbles of gas in the caecal wall. No suspicious liver lesions.
The splenic flexure lesion is causing large bowel obstruction, and the gas in the caecal wall is worrying as it implies that the caecum is becoming ischaemic due to the obstruction. An extended right hemicolectomy confirmed an adenocarcinoma of the splenic flexure and caecal ischaemia, but no perforation.