Case presentation:
A 61-year-old female, medically free, presented to the ER of a Military hospital in Khartoum, Sudan, with severe colicky abdominal pain and right iliac fossa swelling for one month. The pain was sudden onset, severe, intermittent, and colicky in the right iliac fossa, preventing her from doing her daily activities. It was localised, not radiating to other areas, aggravated by food intake and not relieved by analgesics. On further questioning, it was revealed that there were streaks of blood in her stool. However, there was no constipation, diarrhoea, or vomiting. The patient was experiencing loss of appetite and unintentional weight loss, about 15 kg, three months before her illness. BMI: 24.2. There was no fever, night sweats, or cardiopulmonary complaints.
The patient has no history of a similar condition and had not been diagnosed with colon cancer, inflammatory bowel disease, irritable bowel disease or any recent evidence of TB infection.
She has no family history of colon cancer; however, her cousin died of breast cancer three years ago.
She was not on any medication and had no long-term drugs or allergies.
The patient is a cleaning lady in a school, married and lives with her husband and children. She is a non-smoker and non-alcoholic.
On physical examination, the patient looks ill, conscious, vitally stable, not pale nor jaundiced and has no signs of dehydration.
Abdominal examination revealed a right iliac fossa mass, oval in shape, 12×10 cm, irregular surface, normal skin over it and no scars. The mass has an average temperature, tender, hard in consistency, well-defined edges, mobile, not compressible or reducible, and not pulsatile. All hernia orifices are intact, and no lymph node enlargement. However, the rest of the abdominal examination was unremarkable, and the DRE was normal.
The patient has low serum sodium, potassium, total bilirubin and albumin levels. Serum CEA tumour marker was within normal ranges.
Abdominal ultrasound was ordered and revealed the presence of colonic mass and multiple gall stones, but it was otherwise not remarkable.