LOSNONG 57 M 3 months PTA, the Awake, weak Flat Plate Abdomen (10/14/21) Emergency Consistent with a Moderately Moderately

Consistent with a Moderately Moderately Neoadjuvant Chemotherapy

patient noted tapering looking exploratory Differentiated Differentiated
BENJAMIN of stool down to pea laparotomy, colotomy, Adenocarcinoma Specimen Descending Colon
BANTOC size. With no other BP 120/80, HR manual bowel Labeled as “ Descending Adenocarcinoma
assoc symptoms. No 118, RR 24, T There are centrally located decompression, Colon Mass “
melena/hematochezia 36.8, SpO2 96 dilated bowels with associated colorrhaphy, repair of
noted. No consult was at 5-6 lpm via air-fluid levels noted and serosal tear, loop
done. FM prominent valvulae conniventes ileostomy, lavage,
Drain (10/15/21)
Tachypneic, Renal and psoas shadows are
SCWE, no intact
5 days PTA, patient retractions, with
had no bowel clear breath Few retained fecal materials are Emergency
movement, with sounds seen Exploratory
gradual abdominal laparotomy,
enlargement but still Abd: Distended, adhesiolysis,
with flatus. 1 day hyperactive, colorrhaphy, biopsy of
PTA, the patient had hypertympanitic, IMPRESSION: descending colon
distended abdomen (+) direct tumor, drain
with associated tenderness on ABOVE FINDINGS ARE
bloatedness and all quadrants, CONSISTENT WITH SMALL (10/21/21)
vomiting of clear liquid no rebound BOWEL OBSTRUCTION
and previously tenderness, no
ingested food. There guarding, no
was also noted inguinal lymph IOF: Dilated small
Whole Abdominal CT-scan Plain bowels, purulent
obstipation. Few hrs nodes
and Contrast (10/14/21) ascites especially
PTA, there was
persistence of Dre: Good around the cecum,
abdominal pain with sphincter tone, 10x10 cm
markedly distended empty, constricting mass in
A short segment partially
abdomen hence collapsed rectal the mid descending
obstructing enhancing
consult at the ER with vault, no colon, with 10cm
circumferential nodular wall
subsequent palpable mass, serosal tear on the
thickening is noted in the mid
admission. no blood on cecum with point
aspect of the descenfing colon
tactating finger perforation, 6x4cm
measuring 1.9cm in maximal
liver mass, segment
thickness with an involved length
VIII
of 6.2cm. It is about 10.5cm from
the splenic flexure. Surrounding
fatty stranding and nodularities
are likewise noted as well as
secondary thickening of the
anterior prerenal and lateral
conal fasciae.

Suspicious mucosal wall thinning

of the distal portion of the greater
curvature of the stomach just
before the pylorus.

There is also fragmented

thinning of the transverse colonic
wall with segmental
discontinuities exhibiting an
apparent connection with th e
peritoneum.
The rest of the colonic segments
have small perioherally located
gas locules and some exhibit
mild wall thickening.

The cecum is dilated with

maximal diameter of 8.3cm.

Diffuse dilatation of the

visualized small bowel loops
evident, some exhibiting air-fluid
levels and some with focal wall
thickening.

Pneumoperitoneum visualized.
Most of which are adjacent to the
transverse colon. Some smaller
air locules are also noted
adjacent to the descending and
ascending colon. Minimal
abdominopelvic ascites noted,
most in the perihepatic,
hepatorenal, pelvic and
mesenteric regions as well as
the bilateral paracolic gutters.

The liver is unenlarged with an

irregular hypodense lobulated
mass and nodule adjacent to
each other located in segment
VIII. The former/mass measuring
3.0 c 3.0 x 3.0cm has enhancing
septations, is rim enhancing and
shows minimal contrast retention
on postcontrast studies.

The GB is not enlarged with an

intraluminal lamellated
hyperdensity measuring
1.9x2.5cm

Multiple enlarged and prominent

lymph nodes are noted in the
para-aortic , aortocaval and
mesenteric regions, the largest
measures 1.1cm seen in the
mesenteric region.
The kidneys show good
excretory function and are of
normal size, position, and
confihuration. An exophytic
cystic focus measuring
2.2x2.6cm is seen in the superior
pole of the left kidney. A tiny
hyperdensity measuring
0.3x0.3cm is seen in the right
mid interpolar region.

Ancillary finding of multiple thick

linear densities in the
posterobasal segments of both
lower lobes and a possible
1.0cm nodule. The former may
relate to subsegmental
atelectasis vs fibrosis.

IMPRESSION:

Short-segment, partially
obstructing, enhancing
circumferential nodular wall
thickening/mass, mid descending
colon, as described. Worrrisome
looking for a neoplastic process

Secondary intestinal obstruction

Consider enrerocolitis

Suspicious mucosal wall

thickening, greater curvature of
the stomach and transverse
colon, to rule out probable area
of perforation

Pneumoperitoneum and
abdominopelvic ascites

Some of the small gas

collections are in the peripheral
portions of the descending,
transverse and ascending colon,
cannot r/o pneumatosis
intestinalis

Hypodense hepatic mass and

nodule, segment VIII. Can be
worrisome for metastasis

Cholelithiasis

Retroperitoneal and mesenteric

LAD, inflammatory vs metastasis

Renal cyst, left (Bosniak 1)

Tiny non-obstructing
nephrolithiasis, right

Degenerative thoracolumbar
spondylosis

Whole Abdominal Ultrasound

10/30/21

The liver is enlarged with a liver

span of 16.2cm, smooth borders,
cupping of inferior edge, and
homogenous parenchymal
echogenicity. An ill defined
isoechoic mass with
heterogeneously hypoenhancing
rim measuring 3.1 x 3.1
cm.located in segment VIII.

The gallbladder is enlarged

measuring 8.4x 5.2cm with
intraluminal large hyperechoic
shadowing focus measuring
1.9cm and gravity dependent low
level internal echoes. CBD is not
dilated.

A tiny nonobstructing
hyperechoic shadowing focus
measuring 0.3cn is seen in the
right inter-polar region. An
exophytic cyst measuring
2.2x3.0cm is noted in the
superior pole of the left kidney.
The perinephric is unremarkable.

Minimal intraperitoneal fluid

collection with low level internal
echoes are seen*66

Impression

- hepatomegaly with ill defined

isoechoic mass with
heterogeneously hypoenhancing
rim right lobe, correlated with
prev. abdominal ct scan

- GB hydrops with cholelithiasis

and bile sludge with signs of
cholecystitis

- tiny nonobstructibg
nephrolithiasis, right

- simple renal cortical cyst, left

- consider matted omentum and

bowel ileus

- complicated ascites