Presentation
Work up for abdominal pain and chronic constipation.
Patient Data
Marked increased wall thickness with a large exophytic mass is seen at the distal of descending colon and proximal sigmoid, accompanied by severe pericolic fat stranding and desmoplastic reaction. Several extraluminal air bubbles and a 20 mm walled-off paracolic fluid collection are also evident, suggesting tumor site perforation.
Segmental wall thickening is also evident at the adjacent small bowel loops inferring tumoral invasion.
In addition, several regional and para-aortic enlarged lymph nodes are seen with SAD less than 11 mm.
Case Discussion
A large distal descending colon mass with marked surrounding desmoplastic reaction, local invasion into the adjacent small bowel loops and paracolic air bubbles and small walled-off fluid collection suggesting perforation; pathology-proven adenocarcinoma.
Colon perforation is a rare complication in patients with colon cancer, and the perforation characteristics differ based on the perforation site, presenting as either perforation at the cancer site or perforation proximal to the cancer site. In this patient, perforation occurred in the cancer site and walled off with the tumoral desmoplastic reaction.
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