Small bowel obstruction from ileocaecal valve adenocarcinoma

Case contributed by Dr Henry Knipe

Presentation

Three weeks of increasing generalised abdominal pain and vomiting. Bowels not opened for three days.

Patient Data

Age: 65
Gender: Male

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.

Conclusion:

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.

Case Discussion

Colorectal carcinomas that arise at the ileocaecal valve are uncommon, making up only 2% of CRCs. They typically present late due to obstruction, since the contents of the ileum is liquid. 

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Case information

rID: 39071
Case created: 18th Aug 2015
Last edited: 20th Aug 2016
Inclusion in quiz mode: Included

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