92 Sigmoid Colon Adenocarcinoma with Hepatic Metastasis

Clinical Presentation

A 70-year-old patient presents with constipation and hematochezia.

Fig. 92.1 Axial contrast-enhanced CT image of the sigmoid colon shows an enhancing “apple core” lesion causing short segment narrowing (arrow).

Fig. 92.2 Axial CT image of the upper abdomen in the same patient shows a peripherally enhancing hypodense hepatic metastasis in the liver (arrow). Also seen are perihepatic malignant ascites.

Radiologic Findings

Axial contrast-enhanced computed tomography (CT) images through the pelvis show an enhancing “apple core” lesion causing short segment narrowing in the sigmoid colon (Figs. 92.1, 92.2). Figure 92.2 shows a hypodense peripherally enhancing hepatic metastasis in the same patient, along with malignant perihepatic ascites.

Diagnosis

Adenocarcinoma sigmoid colon with hepatic metastasis

Differential Diagnosis

Colitis
Diverticulitis
Inflammatory fibrous polyp
Benign stricture due to inflammatory bowel disease or ischemia or smooth muscle hypertrophy from chronic diverticulosis

Colorectal cancers are the second most common cause of cancer-related deaths in the United States and Europe. The sigmoid colon is the second most common site of colonic malignancy following the rectum.