Presentation
One week of constipation and colicky abdominal pain. Distended. Palpable bowel loops. Soft reducible left inguinal hernia. Virgin abdomen. Cause of obstruction?
Patient Data
Chest
- lungs clear
- dilated small bowel in the upper abdomen
Abdomen
- dilated small bowel, but collapsed large bowel. Gas in the rectum
- prostate calcification
Large irregular mass in the cecum with extension into the terminal ileum. Extraserosal extension into the pericolic fat with multiple enlarge pericolic lymph nodes.
Grossly dilated fluid-filled small bowel.
Small volume free fluid in the pelvis. No free gas.
Multiple low attenuation liver lesions, most likely cysts. Renal cysts.
Left inguinal hernia. Prostatomegaly.
Case Discussion
In the older population, small bowel obstruction or appendicitis may present due to colonic pathology when a right sided colorectal malignancy cover the ileocecal valve or ostium of the appendix.
This case illustrates a colonic malignancy presenting as a small bowel obstruction. The patient proceeded to surgery.
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