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.