From: PK Datta

What type of xray is this, what are the findings and what is the diagnosis?
How does this condition usually present?
What is the standard treatment?

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(See below for further details)

This is a double-contrast barium enema which shows an irregular filling defect in the caecum. This is typical of a polypoid carcinoma of the caecum.

Carcinoma of the caecum can present either as an emergency of electively. As an emergency, patients may come with acute distal small bowel obstruction from an annular carcinoma. The other emergency presentation would be features of "acute appendicitis" when a caecal carcinoma masquerades as acute appendicitis - a presentation that is much more common in the elderly. Therefore, if an elderly patient presents with acute distal small bowel obstruction or atypical features of acute appendicitis and the patient happens to be anaemic, then a carcinoma of the caecum should be strongly suspected. Patients also present electively with classical features of anaemia -shortness of breath at doing the usual activities, malaise and generally not feeling well. Examination of such a patient may show a mass in the right iliac fossa which is firm and depending upon the clinical staging, mobile. Patients with right colonic carcinoma do not present with altered bowel habit because of the liquid nature of the faeces.

In the emergency situation the diagnosis is usually made at operation unless the patient with intestinal obstruction undergoes an urgent gastrograffin enema. The emergency treatment is a right hemicolectomy with ileo-transverse anastomosis. In the elective situation the treatment is the same, namely right hemicolectomy. Once the histology has been obtained with an accurate pathological Dukes' staging, those belonging to Dukes ' stage C are treated with adjuvant chemotherapy. At present those with Dukes' stage B cancer are being put on a trial in certain centres to see if postoperative adjuvant chemotherapy has any beneficial effect.