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Cauliflower Bowel: A Tumor-Induced Mesenteric Retraction
IMAGES
IN THE
MEDICAL SCIENCES
Cauliflower Bowel: A Tumor-Induced Mesenteric Retraction Dimitrios Samaras, MD,* Nikolaos Samaras, MD, Olivier Ferlay, RD, Maria-Aikaterini Papadopoulou, MD and Claude Pichard, MD, PhD *Department of Medical Specialties, Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
CLINICAL PRESENTATION
60-year-old female patient presented with epigastric pain, lower dysphagia, postprandial vomiting and significant weight loss. Upper endoscopy revealed an obstructive lesion of the esophagogastric junction, and biopsy analysis showed a squamous cell carcinoma of low differentiation. Endoscopic ultrasonography, computer tomography and positron emission tomography-computer tomography suggested a T2N1M0 stage. Initial treatment included neoadjuvant chemotherapy with Cisplatin and Docetaxel, followed by a simultaneous chemotherapy and radiotherapy. Four months later, she underwent a subtotal esophagogastrectomy. Follow-up at 2 months showed tumor progression with multiple hepatic metastasis, peritoneal carcinomatosis, and ascites. A “cauliflower” image of the small
330
intestine at abdominal computer tomography (Figure 1) suggested mesenteric retraction. Mesenteric retraction may be the result of autoimmune diseases, abdominal trauma or surgery, mesenteric ischemia or infection and malignancies.1 Evidently, our case was associated with the peritoneal carcinomatosis. The patient’s general condition degraded rapidly, and she was referred for palliative care, where she passed away 2 weeks later. REFERENCE 1. Daskalogiannaki M, Voloudaki A, Prassopoulos P, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol 2000;174:427–31.
The American Journal of the Medical Sciences
Volume 347, Number 4, April 2014
IN THE
MEDICAL SCIENCES
Cauliflower Bowel: A Tumor-Induced Mesenteric Retraction Dimitrios Samaras, MD,* Nikolaos Samaras, MD, Olivier Ferlay, RD, Maria-Aikaterini Papadopoulou, MD and Claude Pichard, MD, PhD *Department of Medical Specialties, Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
CLINICAL PRESENTATION
60-year-old female patient presented with epigastric pain, lower dysphagia, postprandial vomiting and significant weight loss. Upper endoscopy revealed an obstructive lesion of the esophagogastric junction, and biopsy analysis showed a squamous cell carcinoma of low differentiation. Endoscopic ultrasonography, computer tomography and positron emission tomography-computer tomography suggested a T2N1M0 stage. Initial treatment included neoadjuvant chemotherapy with Cisplatin and Docetaxel, followed by a simultaneous chemotherapy and radiotherapy. Four months later, she underwent a subtotal esophagogastrectomy. Follow-up at 2 months showed tumor progression with multiple hepatic metastasis, peritoneal carcinomatosis, and ascites. A “cauliflower” image of the small
330
intestine at abdominal computer tomography (Figure 1) suggested mesenteric retraction. Mesenteric retraction may be the result of autoimmune diseases, abdominal trauma or surgery, mesenteric ischemia or infection and malignancies.1 Evidently, our case was associated with the peritoneal carcinomatosis. The patient’s general condition degraded rapidly, and she was referred for palliative care, where she passed away 2 weeks later. REFERENCE 1. Daskalogiannaki M, Voloudaki A, Prassopoulos P, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol 2000;174:427–31.
The American Journal of the Medical Sciences
Volume 347, Number 4, April 2014