Obstructive splenic flexure colonic adenocarcinoma

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain, nausea.

Patient Data

Age: 60 years
Gender: Male

Mid-distal small bowel and colonic obstruction leading to splenic flexure circumferential mass with several small but abnormal mesocolonic lymph nodes. Separate smaller polyp or mass in the posterior wall of the distal transverse colon. Distal small bowel thickening. Small ascites. Large segment 5 mass. Right lower lobe nodule. 

Case Discussion

Metastatic colorectal cancer presenting with small bowel/colonic obstruction due to splenic flexure mass. Large liver and smaller right lower lobe metastases with abnormal regional lymph nodes. The "apple core" configuration of the mass and regional lymph nodes are displayed best on the coronal images. Often the colonic primary tumors are not particularly large, but appear as circumferential and irregular thickening of the lumen, which can be mistaken for decompressed bowel on axial but often display more "mass-like" appearance on coronal or sagittal reformats. 

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