Tumoral large bowel obstruction and perforation

Case contributed by Dr Ian Bickle

Presentation

Short history of abdominal distension. No motion passed for 2 days. Large bowel obstruction?

Patient Data

Age: 75
Gender: Male

The large bowel is grossly dilated down to the level of a cut-off at the junction of the distal descending and sigmoid colon.

The small bowel is moderately dilated.

Non contrast due to renal impairment.

4.5cm stenosing tumour at the junction of the sigmoid and descending colon with resultant dilatation of the large bowel upto 9cm.   Blebs of intramural gas throughout the colon.

The distal small bowel is dilated due to a incompetent ileocaecal valve.

Multiple foci of pneumoperitoneum in the mid and upper abdomen.

No overt infradiaphrgamatic nodes.

At least two right lower lobe lung nodules, the largest 8mm.

Annotated image

The apple core stricture (blue arrows) of the short stenosing malignant stricture from the tumour with shouldered edges (red arrow) clearly outlined.

The operative findings from the laparotomy that followed the CT abdomen.

Case Discussion

The not so uncommon acute presentation of a colorectal malignancy with a large bowel obstruction.

A small proportion will have perforated at the time of the presentation as in this case.

The short stenosing tumour in the sagittal images has the an 'apple core' appearance classically observed in barium enema studies. 

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Case information

rID: 55375
Case created: 1st Sep 2017
Last edited: 10th Sep 2017
Inclusion in quiz mode: Included

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