Presentation
Abdominal distension and pain.
Patient Data
Diffuse colonic dilation which tapers at an area of mass-like, circumferential thickening in the sigmoid colon. Small amount of free fluid. Pseudopneumatosis of the cecum (intraluminal, dependent gas surrounding stool only, which stops at the air-stool/fluid transition). Scout image.
No adenopathy. No metastases.
PATHOLOGY REPORT (edited):
TISSUES: Sigmoid colon
FINAL DIAGNOSIS:
Colon, rectosigmoid, resection - Adenocarcinoma, pT3 N0.
Case Discussion
Both benign and malignant causes of colonic obstruction can occur. Benign strictures can be from ischemia or inflammation (e.g. recurrent diverticulitis).
In this case, the mass-like thickening and enhancement at the site of transition should strongly raise the suspicion for a malignant stricture due to scirrhous adenocarcinoma, even in the absence of adenopathy or tumor elsewhere.
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