Volume 87 - 2024 - Fasc.2 - Clinical images
A case of atypical rectal tumor in a 55-years-old man?
A 55-year-old patient consulted a gastroenterologist in January 2023 because of recent-onset urgent diarrhea, without rectal bleeding or hematochezia. The patient has a history of diffuse large cell lymphoma with lymph node, bone and suspected small bowel involvement on 18F-FDG-PET/CT imaging, for which a differential diagnosis with a neuroendocrine tumor could not be formally made. He had no other medical or surgical history, and was a former smoker. Physical, digital rectal examinations and laboratory studies were unremarkable.
A colonoscopy was performed and revealed a poly-poid soft formation of non-adenomatous appearance, measuring 30 mm x 30 mm.
Thinking outside the box in lower gastrointestinal bleeding
A 78-year-old man with prior medical history of chronic
kidney disease and atrial fibrillation under apixaban but
no recent abdominal trauma presented to the emergency
department due to acute abdominal pain. The physical
examination was unremarkable except for a distended
hypertympanic abdomen with normal bowel sounds and
painful upper quadrants of the abdomen with no signs of
peritoneal irritation. Laboratory evaluation revealed mild
anemia, leukocytosis and elevated C-reactive protein.
The patient underwent computed tomography (CT) scan
which showed a circumferential bowel wall thickening
of the terminal ileum and cecum with fat stranding. A
conservative medical treatment was chosen including
intravenous antibiotics with partial improvement. Within
11 days of admission, the patient developed melena
followed by hematochezia. Upper endoscopy showed no
signs of bleeding while colonoscopy (Figure1) revealed
an endoluminal dark red-brown mass partially covered
by necrotic and yellowish mucosa in the cecum with
extensively ulcerated surrounding mucosa. Ileoscopy
was not possible since the mass obstructed the ileocecal
valve. An angio-CT (Figure 2) was then performed
showing a 58x29x37mm hyperdense mass with no signs
of active bleeding or thickening of the ileocecal wall.
