Case 299

Case 299

Medical history

Female, 79-years-old, complaining of diffuse abdominal colicky pain, associated with constipation and vomiting, in the last 6 months. On examination: distended abdomen, palpable and hardened mass with approximately 5cm (2 inches) on the lower right quadrant. No signs of ileus or peritonitis. Comorbidities: diabetes mellitus type 2, hypertension, heart failure, chronic kidney disease stage III and anemia. Exams were requested: abdominal radiography (no abnormalities), colonoscopy (image 1) and, in sequence, computed tomography of the abdomen, pelvis and thorax (images 2, 3 and 4).

According to the pictures shown and the clinical findings of this patient, what is the most adequate treatment?

Test question

(Residência Médica 2012 – PUCRS)

Male, 71 y.o., presents pale and skinny to the office. He has been taking iron supplement for more than one year. He refers passing black tarry stool 2 to 4 times a day. According to the information provided, judge the following statements:

I.Colorectal cancer screening starts with Fecal Occult Blood Test

II.The presented patient should be submitted to colonoscopy, which could be both diagnostic and help with staging the disease

III.A Computed Tomography scan is essential for this patient. It’s the chosen exam for not being invasive

IV.Surgical resection, R0, on the TNM system, is defined as: absence of tumor on both clinical and pathology analysis of the margins of the resected organ.

I. O rastreamento para câncer colorretal na população inicia-se por pesquisa de sangue oculto nas fezes.

II. No caso do enunciado o exame inicial deveria ser a colonoscopia, que pode ser diagnóstica e auxiliar no estadiamento.

III. Nesse caso o exame essencial para o diagnóstico é a tomografia computadorizada. É o exame de escolha por ser menos invasiva.

IV. A ressecção cirúrgica (R) no sistema TNM é definida como R0: ressecção tumoral considerada pelo cirurgião como completa com todas as margens negativas examinadas pelo patologista.

It is correct what is stated ONLY in: