Case 3 10/6/2013
53 years old male patient named Abdullah Muhammad Misyali from Bil Az, Egypt, working as a farmer, has 2 sons and 3 daughters, complaining of acute abdominal pain since 4 months ago. He described the pain is like stabbing and comes intermittently. The pain is also aggravated by eating and relieved when he is hungry.
On general examination, there is loss of weight about 5-10 kg , fever at 38 ⁰C, night sweating and also fatigue. He has no past history of other medical disease or any surgery. He’s taking magnesium citrate, encarbon and castor oil. His brother has the similar condition. Some investigations have been made.
Abdominal US reveals mural thickening at ascending colon giving pseudo kidney appearance. CT is done to exclude malignancy.
Triphasic CT of abdomen shows circumferential thickening of the right side of transverse colon near the hepatic flexural by soft tissue density mass infiltrating the surrounding fat planes measuring about 2.7cm, suggest malignancy. There is enlargement of para-colonic lymph nodes,largest measuring about 2cm. The surrounding organs are normal and no ascites detected.
Barium enema reveals a short segment of persistent stenosis in the proximal transverse colon showing mucosal destruction and shouldering with apple core appearance. The patient is then assigned to do colonoscopy.
The colonoscopy is done up to ascending colon (due to bad preparation) revealed small rectal mass. Multiple biopsies are taken from it. The pathology report shows superficial biopsy consistent with villous adenoma with moderate dysplasia and no evidence of stromal invasion.
Tumor marker CEA and CA 19-9 are also ordered for the patient.