Bowel obtruction by tumour

Case contribution: Dr. Radhiana Hassan


  • A 38 years old man
  • No known medical illness
  • Active smoker
  • Previously under follow up for gastritis, OGDS done confirming the diagnosis
  • Presented with sudden onset abdominal pain at epigastric region
  • Colicky, non-radiating
  • Associated with nausea and vomiting
  • Clinically per abdomen distended but no peritonism
Abdominal radiograph shows dilated bowel loops, mainly involving the small bowel. Rectal air and sigmoid colon is seen normal.
CT scan of abdomen and pelvis in soft tissue window post contrast axial plane.

CT scan findings:

  • Dilated small bowel loops are seen, mainly the small bowels
  • Fluid levels are seen within the dilated bowel loops
  • No obvious bowel wall thickening, no mass seen
  • No free air or free fluid
  • No paraortic or paracaval node enlargement

Intra-operative findings:

  • Exploratory laparotomy done
  • 100 cc clear peritoneal fluid, no pus, no fecal material
  • Mobile constricting tumour at mid transverse colon causing dilatation of proximal colon and small bowel, distal colon appeared collapsed
  • No liver nodule no peritoneal nodule
  • Extended right hemicolectomy with end ileocolic anastomosis

Progress of patient:

  • Complicated with anastomotic leak
  • Also had enterocutaneous fistula
  • HPE: adenocarcinoma, moderately differentiated TNM staging T3N1Mo

Diagnosis: Bowel obstruction due to colon carcinoma


  • Bowel obstruction is any mechanical or functional obstruction of the intestine that prevents physiological transit and digestion.
  • Colonic carcinoma is the most common cause of intestinal obstruction.
  • Bowel obstruction may appear at any time during the evolution of the disease, but is more frequent in cases of advanced cancer.
  • Intraluminal tumors may occlude the bowel lumen or provoke intussusception.
  • Intramural infiltration through the mucosa may obstruct the lumen or impair peristaltic movements.
  • Mesenteric and omental tumor involvement may angulate the bowel and provoke extramural bowel occlusion.
  • Infiltration of the enteric or celiac plexus may cause severe impairment in peristalsis and consequent obstruction due to dysmotiliy.
  • The radiological signs are distension of the intestinal loops, fluid retention, and gases with the presence of air-fluid levels in the zone proximal to the occlusion as well as a reduction in gas and stools in the segments distal to the obstruction. In upper occlusions, distension of the loops and air-fluid levels may be absent.
  • Contrast studies such as barium enema may may be necessary to evaluate the surgical approach in certain cases.
  • Computerized tomography (CT) provides a high possibility for the diagnosis of the extension of the neoplasm and on many occasions, the level of obstruction.
Author: radhianahassan