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In 1990 colonoscopy revealed multiple lipomas in the left colon and rectum. There was also a central lower abdominal mass reaching the level of the umbilicus. Laparotomy revealed a deep abdominal wall tumor (12 × 9cm) attached to the sigmoid colon, bladder, and a tube-ovarian mass containing a cystadenoma (14 × 14cm). These lesions were removed. An ulcerated polypoid lipoma (6 × 2.5cm) was removed from the splenic flexure by colotomy. The histology of the abdominal wall tumor revealed a fibroblastic pattern (no mitoses) and chronic inflammatory cells. Diagnosis: inflammatory pseudotumor

The patient had a family history of colorectal cancer (father). He presented with a 10-day history of central abdominal pain, anorexia, and fever. A rapid loss of weight had occurred during this period. He was admitted to a hospital where colonoscopy revealed a polypoid mass at 30cm. This was diagnosed as a carcinoma and the patient was referred for operation. A further colonoscopy to the cecum was performed. The lesion was of an intense red color, lobulated, and with a smooth surface (Figure 22.1). Immediately proximal to it there was a less prominent but similar change in the mucosa. Diverticula were present in the sigmoid and descending colon. There was no other mucosal abnormality. Biopsy revealed mucosal inflammation. On rectal examination, there was a fixed left-sided pelvic mass. A preoperative diagnosis of diverticulitis was made.

The patient was found to be anemic (hemoglobin 8.0 g/L) when investigated for an episode of syncope. Fecal occult blood test was positive. Colonoscopy identified an annular carcinoma in the ascending colon and a large pedunculated polyp at the 15cm level in the rectum.

The patient’s complaint was an aggravation of prolapsed “hemorrhoids” for 2 months. She had noted occasional constipation but no other gastrointestinal symptoms. Physical examination revealed circumferential mucosal prolapse and a large mass, readily palpable in the pelvis. Sigmoidoscopy identified the proliferative edge of a rectal carcinoma at 16cm, confirmed by biopsy. Further examination of the bowel proximal to the tumor was not possible. Computerized tomography (CT) examination identified an abnormality at the rectosigmoid area with extensive thickening of the bowel wall and diverticular disease. There was dilatation of the right ureter. The liver showed no evidence of metastases.

During a 2-month period, the patient had noticed a loss of weight, abdominal “wind” pain, and diarrhea. Rectal examination revealed a mobile mass in the pelvis, and sigmoidoscopy was normal to 19cm. A barium enema showed complete retrograde obstruction in the lower sigmoid colon consistent with a neoplasm. Flexible endoscopy was not performed.

This patient presented with symptoms due to iron deficiency anemia (Hb: 59g/L) made worse by his chronic bronchitis and emphysema, which required oxygen administration at home. A barium enema showed a large carcinoma of the transverse colon. Short colonoscopy to the distal extent of the tumor revealed 3 small polyps in the left colon and sigmoid colon diverticulosis.

The patient’s prior medical history included hypertension, a myocardial infarct, and diabetes. For 1 year, frequent episodes of diarrhea had been present. For 3 months, she complained of lower abdominal pain, worse after meals, abdominal distention, audible bowel sounds, anorexia, and loss of weight. A barium enema examination demonstrated a large lesion of the distal sigmoid colon. On examination, there was abdominal distention and an irregular, immobile pelvic mass. Sigmoidoscopy revealed a polypoid tumor of the rectum at 10 cm. Biopsy confirmed the lesion to be a moderately well differentiated adenocarcinoma.

In 1981 the patient (aged 37 years) underwent colectomy and ileorectal anastomosis for chronic ulcerative colitis complicated by mucoid carcinomas (2) of the ascending colon that had penetrated beyond the muscularis propria (Dukes B, T N M). He remained well until 1995, when he presented with a 3-month history of abdominal pain and localized distention on the left side of the abdomen. Examination revealed a firm mass in the left iliac fossa accompanied by distended loops of small bowel. The findings were confirmed by computerized tomography (CT) examination.

The patient presented with a 2-year history of diarrhea and intermittent rectal bleeding. Colonoscopy was limited to 30cm by a large polypoid mass thought to be carcinoma. Biopsies were inconclusive. There were 6 polyps in the rectum 10mm–20mm size. A barium enema confirmed these findings, suggesting there was infiltration by the large sigmoid lesion as well as additional small polyps in the descending colon (10) splenic flexure (1) and hepatic flexure (1).

The patient complained of rectal bleeding, diarrhea, and lower abdominal discomfort for 2 months. There had been a weight loss of 35 lbs in 12 months. A nonmobile mass was present in the left lower abdomen. On rectal examination and sigmoidoscopy, abnormal mucosa was present that was not typical of adenocarcinoma. Crohn’s Disease was considered prior to referral. A barium enema demonstrated a long stricture with “scalloped” margins involving rectum and sigmoid. Biopsy of “inflamed and edematous mucosa” at 10cm revealed anaplastic carcinoma. Biopsy of an enlarged lymph node in the neck (Figure 30.1) showed anaplastic carcinoma with signet ring cells present. Other investigations revealed the patient was suffering from thyrotoxicosis, and therapy with carbimazole was commenced. Despite the ominous prognosis, operation was performed since the patient had constant rectal symptoms and requested that at least an exploratory laparotomy be undertaken.