Presentation
Abdominal pain.
Patient Data
Obstruction of the small and large bowel with transition in the left upper quadrant at an irregular splenic flexure mass. Few adjacent abnormal lymph nodes. Distal large bowel decompressed. No liver masses.
Case Discussion
Later presentation of obstructive colonic adenocarcinoma with both large and small bowel obstruction. This degree of small bowel dilation may be misleading and make it difficult to identify the mass in the splenic flexure causing the obstruction. It is important to run the bowel in both directions, but in the case running the large bowel backwards from the decompressed rectum/sigmoid/descending colon can lead you to the mass and start of the obstructed colon in the distal transverse segment.
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