Small bowel obstruction from ileocaecal valve adenocarcinoma
Three weeks of increasing generalised abdominal pain and vomiting. Bowels not opened for three days.
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Dilated loops of small bowel with air fluid levels. Paucity of gas within the colon, which is generally collapsed. The terminal ileum and caecum is thick walled and enhancing, with the impression of a mass. The appendix is thickened and enhancing although there is no significant periappendiceal fat stranding.
Enlarged para-aortic lymph nodes. No free gas. Trace of free fluid. Soft tissue density is is seen within the peritoneal in the right paracolic gutter.
Distal mechanical small bowel obstruction with the level of obstruction being centred on the ileocaecal valve. The caecum, terminal ilium and appendix are all thickened and enhancing. Enlarged para-aortic lymph nodes. Overall, appearances are suspicious for a caecal malignancy.
The patient proceeded to right hemicolectomy.
Histopathology: Sections of the lesion noted macroscopically at the ileo-caecal valve show an ulcerated, poorly differentiated, partially mucinous adenocarcinoma involving predominantly caecal mucosa and wall but also involving terminal ileum and appendix. Extensive lymph node metastases.