Beyond colonic neoplasia

An 81-year-old woman with hypertension and type 2 diabetes was admitted to the emergency department complaining of 2-months abdominal pain without fever, weight loss or abdominal trauma. Physical exami- nation revealed a large palpable mass at the right iliac fossa. Laboratory parameters showed microcytic normochromic anaemia (haemoglobin:10.1g/dL) with normal white blood cell count (8.9x109/L) and C-reactive protein (0.49; N<0.5mg/dL). Plain abdominal X-ray showed no air-fluid levels or pneumoperitoneum. Abdominal ultrasonography was performed revealing a 9cm heterogeneous thickening of the mesenteric fat of the anterior abdominal wall at the right iliac fossa. Tumor markers (CEA and CA 19.9) were normal. Abdo- minopelvic computed tomography revealed a 10cm lesion at the right abdominal wall involving the ascending colon (Figure 1-A,B). Colonoscopy was performed with an intense cecum deformation with mucosal congestion (Figure 1-C).