2017-07-03 19:06:21 UTC

Unusual Cause of Hematochezia

July 3, 2017

A 73-year-old woman with an ulcerated partially obstructing large mass in the right colon, experienced two episodes of hematochezia, in this week’s Gastroenterology image challenge.

Gastroenterology Clinical Image Challenge: A 73-year-old woman experienced two episodes of hematochezia two weeks before her admission. She had been treated for mild hypertension, and had a history of cholecystectomy, appendectomy, two C-sections and unspecified pancreatic surgery 17 years prior. At presentation, her laboratory examinations showed a mild anemia (hemoglobin, 10.7 g/dL; hematocrit, 33.5%) and a slight increase of alkaline phosphatase (169 U/L; normal range, 45-129). She underwent colonoscopy at an outside hospital, which demonstrated an ulcerated partially obstructing large mass in the right colon. A contrast-enhanced computed tomography (CT) scan was subsequently requested in our hospital. Contrast-enhanced CT scan showed an 18.0 × 17.0-cm large pancreatic multilobulated cystic mass in the head of the pancreas with innumerable central calcifications (Figure A). CT images also demonstrated that the mass was composed of numinous central small cysts and some peripheral larger cysts (Figures A, white asterisks). The pancreatic mass was associated with pancreatic atrophy, biliary and pancreatic ducts dilatation (Figures A, black asterisks), encased the superior mesenteric vein (Figure A, black arrow), and displaced the duodenum (Figure A, white arrows). The pancreatic mass also infiltrated and protruded into the right colon lumen (Figure A, dashed arrows).

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play

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