Diagnosis of a cecal tumour with virtual colonoscopy

Abstract

The authors presented a 75-year-old female patient at high risk, suspected of a cecal cancer (CC) due to discomfort in the inguinal fossa, microcytic anemia (although she was postmenopausal), liquid stools and a positive faecal occult blood test. A standard examination of the large intestine was undertaken. Conventional colonoscopy was not completed and the results of barium enema were questionable. Therefore, virtual colonoscopy (VC) was performed, which helped to localize an accurate operation site. As a result, the patient underwent right hemicolectomy. Postoperative histopathological assessment confirmed an advanced cecal cancer. Traditionally, double-contrast barium enema is used to evaluate the colon in patients after incomplete colonoscopy. However, the accuracy of this test is lower in comparison to endoscopy or VC. An incomplete colonoscopy examination may occur in up to 10% of patients. Tortuous course of the colon, diverticulosis, strictures, obstructing mass and fixation of colonic loops due to adhesions after surgery are the most common causes of incomplete examinations. To sum up, VC can be an alternative method of evaluation of the large bowel in patients after an incomplete colonoscopy examination, as follows from the presented case and the available literature.

Keywords: cecal cancer; incomplete colonoscopy; virtual colonoscopy.

Figure 1.

Double-contrast barium enema, caecum dilated with barium contrast.

Figure 2.

Double-contrast barium enema, caecum dilated with air.

Figure 3.

Virtual colonoscopy (A) coronal, (B) transverse, (C) sagittal, two-dimensional (2D), MIP reconstruction with soft tissue window-level settings shows a ceacum tumour.

Figure 4.

Virtual colonoscopy, three-dimensional (3D), VR endoluminal image shows the simulated endoscopic appearance of the lesion.