Presentation
Bowels not open four days. Vomiting. Distended and tender abdomen. Likely fecal overload.
Patient Data
Marked colonic dilatation with a paucity of colonic gas in the pelvis is highly concerning for a distal large bowel obstruction. Multiple air- fluid levels. No free gas identified.
Portal venous phase study. Rectal contrast has been administered.
Marked distension of the large bowel from the cecum to approximately the level of the mid descending colon where there is a focal stenosing lesion with shouldering. Rectal contrast passes across the lesion indicating that there is not complete obstruction. Adjacent to the descending colon lesion is fat stranding and free fluid.
Case Discussion
The patient proceeded to an extended right hemicolectomy.
Histopathology report
DIAGNOSIS:
- Site: Extended right hemicolectomy.
- Type: Moderately differentiated adenocarcinoma.
- Size: 36mm in maximum dimension.
- Local invasion: Tumor extends through muscularis propria into the subserosa. Serosa is clear.
- Lymphovascular invasion: Present.
- Lymph nodes: 3 out of 33 lymph nodes show metastatic tumor. Largest tumor focus 5mm. Extranodal spread seen.
- Margins, proximal and distal: Clear.
- AJCC stage IIIB (T3 N1b M0).
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