Question 2 Answers

1. Name the radiological investigation and list the radiological findings (2.0 marks)

• Dilated loops of large bowel (haustral folds visible peripherally)
• Distended proximal colon with air-filled loops
• Possible small bowel dilatation (if ileocaecal valve is incompetent)
• The pattern indicates a large bowel obstruction with the point of obstruction in the right side of the colon/caecum

2. State the diagnosis with justification (2.0 marks)

• Right iliac fossa lump for 3 months → a palpable mass in the RIF is the hallmark of caecal carcinoma
• 5 kg weight loss in 3 months → constitutional B-symptoms typical of malignancy
• Pale appearance → iron-deficiency anaemia, classically caused by right-sided colon cancer (chronic occult blood loss)
• Acute colicky abdominal pain + vomiting → now developing large bowel obstruction as the tumour occludes the lumen
• AXR shows large bowel obstruction — carcinoma of the colon is the most common cause of large bowel obstruction in the UK/USA

3. State ONE investigation to confirm the diagnosis (0.5 marks)

• This is the gold-standard investigation; it will identify the obstructing caecal mass, assess local invasion, and detect distant metastases.
• (Alternatively: colonoscopy with biopsy — but CT is preferred acutely given the obstruction)

4. Name the operation recommended to treat this condition (0.5 marks)

• This involves resection of the caecum, ascending colon, and part of the transverse colon, with ileocolic anastomosis.
• If presenting as an acute obstruction, an emergency right hemicolectomy may be performed.