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Case 268.

Fatima D Alves Pereira1, Melissa L Hickson1, Paddy A J Wilson1

  • 1From the Department of Radiology, Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, England.

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Summary
This summary is machine-generated.

A 65-year-old man with metastatic appendix cancer developed small-bowel obstruction and sepsis. Imaging confirmed obstruction, and clinical deterioration indicated a severe systemic inflammatory response. This case highlights complications of advanced appendiceal adenocarcinoma.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Radiology

Background:

  • A 65-year-old male with a history of metastatic primary appendiceal adenocarcinoma presented with symptoms of small-bowel obstruction.
  • The patient had a recent hospitalization for small-bowel obstruction requiring laparotomy and loop ileostomy.
  • His medical history also included basal cell carcinoma, rheumatoid arthritis, and Barrett esophagus.

Purpose of the Study:

  • To present a case of a patient with metastatic appendiceal adenocarcinoma experiencing recurrent small-bowel obstruction and subsequent sepsis.
  • To illustrate the diagnostic utility of computed tomography (CT) in evaluating complex abdominal pathologies in oncology patients.

Main Methods:

  • Clinical presentation and history of a 65-year-old male with metastatic appendiceal adenocarcinoma.
  • Physical examination findings including abdominal distention, tenderness, and reduced bowel sounds.
  • Initial abdominal plain-film radiography revealing dilated small-bowel loops.
  • Subsequent abdominal and pelvic CT with intravenous contrast to further assess the obstruction and associated complications.
  • Laboratory investigations including C-reactive protein, white blood cell count, red blood cell count, hemoglobin, and hematocrit.

Main Results:

  • Initial radiography suggested small-bowel obstruction, managed conservatively.
  • The patient developed sepsis with tachycardia, tachypnea, and hypotension, accompanied by elevated inflammatory markers (CRP, WBC) and anemia.
  • CT imaging provided detailed visualization of the abdominal and pelvic structures, aiding in the assessment of the obstruction and its sequelae.

Conclusions:

  • This case underscores the potential for recurrent small-bowel obstruction as a complication of advanced appendiceal adenocarcinoma.
  • The development of sepsis in this context signifies a critical deterioration requiring prompt recognition and management.
  • Multimodal imaging, including CT, plays a crucial role in the diagnosis and management of such complex gastrointestinal oncological emergencies.