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Virtual case of the month
Bowel obstructed by bone
  1. James J Sun1,
  2. John Firth1,2,
  3. Lee S Dvorkin1
  1. 1 Department of Colorectal and General Surgery, North Middlesex University Hospital NHS Trust, London, UK
  2. 2 Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
  1. Correspondence to Dr James J Sun, North Middlesex University Hospital NHS Trust, London N18 1QX, UK; james.sun{at}nhs.net

https://doi.org/10.1136/jclinpath-2019-206130

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    Clinical question

    A 37-year-old man presented with a 2-week history of crampy abdominal pain and bloating. This was associated with vomiting, loss of appetite and absolute constipation. He was otherwise fit and well with no medical or family history of note. CT imaging showed large bowel obstruction with a transition point 10 cm from the splenic flexure. There were areas within the lesion with the same attenuation as bone. Flexible sigmoidoscopy showed an obstructing tumour 65 cm from the anal verge. A laparotomy and resection were performed. The histology of the transverse colon tumour is shown (see figure 1).

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors All authors contributed to the conception, writing and revising of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Commissioned; internally peer reviewed.