Presentation
Bleeding per rectum.
Patient Data
Double-contrast barium enema demonstrates a focal narrowing in the sigmoid colon. It has rolled, heaped up shoulders and results in a severe stenosis. Features are typical of the so-called apple-core stenosis. The remainder of the imaged colon appears normal in caliber, and lined by normal mucosa.
CT of the abdomen and pelvis obtained with oral and intravenous contrast demonstrates a focal thickening of the sigmoid colon with stenosis of the lumen but no evidence of an established obstruction. No clear fat plane between the mass and the rectus muscle is identified although there is no convincing evidence of direct extension.
A number of enlarged local lymph nodes are seen in the adjacent mesentery. No convincingly enlarged retroperitoneal nodes are noted, however an umbilical nodule is present.
The liver contains a number of low attenuation ill-defined lesion, the largest in segment 5.
Simple left renal cyst noted. Lungs and mediastinum appear unremarkable (although lung windows should of course be reviewed for small deposits).
Case Discussion
This case unfortunately demonstrates advanced colorectal carcinoma (pathologically proven well differentiated adenocarcinoma) in a young patient. It should act as a reminder that although typical age-range is a great way of limiting a differential diagnosis, most pathologies are sometimes encountered well outside the expected age groups and as such age alone is not enough to discount a diagnosis.
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