Dr. Mario Pagès

Radiological finding during the study of colonic adenocarcinoma

This video shows the investigation sequence in a patient diagnosed with colon cancer and suspected peritoneal carcinomatosis. She is a 40-year-old female with no drug allergies or toxic habits. There was only one episode of mild pancreatitis during pregnancy and a caesarean. She presented constipation and rectal bleeding, so a colonoscopy was performed showing a proliferative ulcerated lesion covering 4/4 of the circumference 18 cm from the anal verge, which did not allow the passage of the endoscope. A virtual colonoscopy with 3D reconstruction was conducted, showing an occlusive neoplasm at the sigmoid colon. Also an image of a solid lesion attached to the small bowel located at the lower right quadrant with hipervascular appearance. The differential diagnosis for this type of lesion is: 1.- A peritoneal implant. 2.- A gastrointestinal stromal tumor (GIST) 3.- An appendiceal tumor. Further investigation was carried out to prevent the patient from being excluded from curative  surgery. The lesion in the small intestine was identified at the coronal and transverse cuts. 3D navigation suggested that this tumour was dependent on the gut lumen, a finding that suggested a diverticulum. The barium enema also revealed  a diverticular image filled with contrast coming from inside the small bowel, which allowed us to rule out a suspected peritoneal implant, leading to the diagnosis of a Meckel’s diverticulum. Surgical treatment was performed by laparoscopy, including a sigmoidectomy and the simultaneous resection of the diverticulum. The postoperative period was uneventful. The pathological anatomy revealed a pT3N0 colonic adenocarcinoma plus a diverticulum with a heterotopic mucosa and no evidence of malignancy.