Presentation
Several days of left lower quadrant pain. Change in bowel habit and PR bleeding. History of colorectal cancer 5 years ago and right hemicolectomy.
Patient Data
Evidence of prior right hemicolectomy. Descending colon intussusception (colocolic) remote and distal to the enterocolic anastomosis with associated bowel wall thickening and pericolonic fat stranding. In the central intussusceptum is an irregular enhancing mucosal-based lesion approximately 20 mm thick and 40 mm in length. Proximally the colon is mildly distended. Diverticulosis of the sigmoid colon. No evidence of perforation. No intra abdominal free fluid.
Multiple hypodense lesions in the liver, largest measuring up to 21mm. These likely represent hepatic cysts. Adrenals, kidneys, pancreas and spleen are unremarkable.
Normal opacification of the abdominal vessels. No CT size significant lymphadenopathy. Small fat-containing umbilical hernia.
No suspicious osseous lesion. No lung base nodules.
IMPRESSION
descending colon intussusception with a mucosal-based solid lesion (leadpoint) highly suspicious for primary colorectal malignancy
distended bowel proximally that represents partial/developing obstruction
no evidence of perforation or metastatic disease
Case Discussion
The patient underwent flexible sigmoidoscopy which confirmed a large obstructing tumor. The intussusception resolved during the procedure. Biopsies confirmed recurrent colonic adenocarcinoma.
Four days later the patient underwent laparoscopic left hemicolectomy and histology confirmed moderately to poorly differentiated colorectal adenocarcinoma.
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