2. HISTORY
A 62 years o housewife, resident of Kanhan , came with
chief complaints of -
Pain in abdomen since 2 months
Decreased appetite and generalised weakness since 2
months
3. HOPI
Patient was apparently alright 2 months back ,when she
noticed pain in right lower abdomen insidious in onset
,intermittent, dull aching, mild in intensity ,non radiating ,
without any aggravating factors , pain relieved on
medication.
4. Patient also complains of decreased appetite ,easy fatiguability with
generalised weakness , which is associated with loosening of clothes since 2
months.
h/o passing black coloured stools (not sticking to pan) since 2 months. (
patient also gives history of taking iron supplementation for the same
duration )
h/o intermittent diarrhoea + present since 2-3 months lasting for 1 to 2 days.
5. No h/o yellow discoloration of skin and eyes.
No h/o urinary complaints
No h/o fever
No h/o Koch or Koch contact.
Patient is newly diagnosed Hypertensive on medication ( T Amlo 5
mg OD) .
6. PAST HISTORY
H/o PR bleed 5 years back intermittently present after defecation for which
patient was managed conservatively at local hospital . No h/o PR bleed since
last 2 years.
Patient is known case of Depression on antidepressive medication since last 2
years.
Patient has Facial tics since 1 year for which patient is taking medication since
last 1 year.
Tubal ligation done 36 years back.
Patient was operated for cataract 6 years back and 12 years back.
7. PERSONAL HISTORY
Patient has decreased appetite and disturbed sleep since 2
months .
Patient is post menopausal since last 12-15 years. No h/o
any addictions.
No similar history in family members.
8. GENERAL EXAMINATION
Patient is conscious , cooperative and well oriented to time place
and person.
Moderately built and nourished
BMI- 22.2 kg/m2
ECOG performance score- 2
9. Patient is Afebrile
Pulse- 94 beats per min in right radial artery with normal rhythm and volume
Blood pressure- 130/80 mm of Hg in right brachial artery in supine position
Respiratory rate – 16 cycles / min thoraco- abdominal.
Pallor ++ , B/L Pedal edema +
No icterus, cyanosis, clubbing , or generalised lymphadenopathy.
10. PER ABDOMEN EXAMINATION
Inspection
Contour of abdomen is flat
Umbilicus is at centrally located and inverted
Tubal ligation scar mark +
All quadrants moves with respiration
Skin over abdomen is normal
No visible peristalsis , no diated veins over abdomen.
All hernial sites are normal
No renal angle fullness
11. Palpation
No local rise of temperature.
A lump of size 7 x 5 cm present in right lumbar and illiac
12. Percussion
Dull note present over the lump in right lumbar region.
No evidence of free fluid in abdomen
Auscultaion
Bowel sounds present.
Per vaginal examination
With in normal limits
Digital rectal examination
E/o external hemorrhoid at 7’oclock position , no e/o any growth , fecal staining +.
13. Systemic examination
Cardiovascular system- S1,S2 normal
Respiratory system- Air entry equal on both sides
Central nervous system – conscious and oriented
Spine - normal
14. PROVISIONAL DIAGNOSIS
A Case of Ascending colonic malignancy
Other Clinical differentials :
Appendicular lump
Ileocecal tuberculosis
15. INVESTIGATIONS
USG(A+P)- Circumferential bowel wall thickening in noted in Ascending colon, caecum and terminal
ilium .
- No sign of obstruction.
- Diffuse mesenteric fat stranding noted.
Liver: Measures 13.5 cm . There is e/o relatively , will defied heterogenous hypoechoic lesion noted in
segment VII & VIII of right lobe of liver measuring approx 4.5x 4.5 x 5 cm
f/s/o infective aetiology of liver ?Abscess formation ?Neoplastic .
16. CECT(A+P) 28/1/23
-Mild to moderate circumferential asymmetric moderately enhancing irregular mural thickening involving
terminal ileum, IC junction, caecum and ascending colon causing moderate luminal obstruction with
moderate changes of intestinal obstruction in the form of dilated small bowl loops. Mild surrounding fat
stranding with few sub cm sized reactive lymph nodes seen.
•Possibility of infective/ inflammatory etiology is likely. Neoplastic etiology appears less likely.
•Well defined hypodense peripherally enhancing lesion (3.8x3.6x3.4 cm) with shaggy irregular wall and
peripheral rim of edema seen involving segment VIl of right lobe of liver. Another small similar density
lesion seen adjacent to above mentioned lesion.
