- Corpus, pedicle and spatium intervertebralis seems good
Reporting patient male, fourty six years old, reffere from surgery
department with clinical information suspect Ca colon ascenden
asked for colon in lopp
From history taking we got :
Patient complain of having abdominal pain since four months
ago and have difficulty in defecation about once a week. This
complaint causes the patient’s weight decreased and loss of
appetite
Ten days later, he was hospitalized for 3 days in pare hospital
and has undergone ileustomy surgery and the dokter stated the
patient have abdominal mass
After that the patients is reffered to soetomo hospital and he had
undergone CT abdomen in date october 17 th 2017 (oktober
sevententh tweny seventeen) with the result :
- enhancing solid mass size approximately 2.9 x 3,4 x 3,6
cm in intralumen colon ascenden wall
- lymphadenopathy paracolic
- minimal bilateral pleura effusion
- spondylosis lumbalis
From plain foto we got :
- Bowel gas is normal
- Liver and spleen shadow are not enlarged
- Right and left kidney not clearly seen
- There is no radioopaque shadow along urinary tract
- Both of psoas shadows are simetric
Contras study :
- About 800 (eight hundred) cc of barim was administrated
into the anus through foley cateter
- Contrast fill rectum, rectosigmoid, sigmoid, colon
descendent,flexura lienalis, and partially colon
transversum, flexura hepatica , untill partially colon
ascendent
- Then patient in rolling and kontras then is evacuated, and
the air pump as a double contrast
- Double contrast fill rectum, rectosigmoid, sigmoid, colon
descenden, flexura lienalis, colon transversum, flexura
hepatica, colon ascenden untill caecum
- There is no kontras fill ileocaecal junction
- There is filling defect in colon ascenden which causes the
narrowing of the lumen along +/- 3,5 cm , and gives apple
core appearance
- Mucosa and hausta rectum, rectosigmoid, sigmoid, colon
descenden, flexura lienalis, colon transversum seems
good
- There is no additional shadow
- there is no leakage or extravasation of contrast
- there is no fistel tract appearance
conclusion :
- massa colon ascenden with annular type which causes
the narrowing of the lumen along +/- 3,5 cm
 - Spesifik
3.CA COLON 3. Toxic Megacolon (Acute Toxic Dilatation )
CA COLON terbagi dalam 3 tipe : 4. Tumor Colon
1. Fungating - Jinak : adenoma, polyp, papilloma, peutz jager syndrome )
 Patologi : Biasanya medullary carcinoma - Ganas : Ca colon
 Lokalisasi : caecum, colon ascendens,rectum 5. Invaginasi : intussusepsi
 Komplikasi : perdarahan, fistula
1. Tempat penyempitan ( variasi normal ) colon ada 7 yaitu :
2. Annuler (ulcerative) → Apple core sign
 Patologi : - mucoid adenocarcinoma
- scirrhous fibrocarcinoma
 Lokalisasi : colon sigmoid, colon
descendens,kedua flexura
 Komplikasi : - fistula
- Obstruksi : 1/3 kasus menunjukkan
tanda-tanda obstruksi akut
3. Polypoid (vegetative)
 Patologi : Biasanya medullary carcinoma
 Lokalisasi : caecum, colon ascendens,rectum
 Komplikasi : perdarahan, fistula

2.KELAINAN PADA COLON

1. Kelainan Congenital : (Raden Mas Bagas Pujomartono Cholid Hamat Baidlowi )
- atresia/ imperforatus ani
- stenosis colon 1. Busi → caecum
- hirschprung = megacolon 2. Hirsch → colon assenden
2. Inflamasi colon (colitis ) 3. Canon’s ring → colon transversum
- Non spesifik : Crohn’s disease, Ischaemi disease, Col ulcerative 4. Payr strauss → proximal colon desenden
5. Balli → distal colon desenden
6. Moutier → Sigmoid
7. Rossi → rectum

Ada referensi lain yang menyebutkan Moutier dulu baru

rossi :
Location
Colorectal cancers can be found anywhere from the caecum to the rectum, in o into non-peritonealised pericolic/perirectal tissues
the following distribution 2,5:
 T4a: penetration of the visceral peritoneal layer

 recto-sigmoid: 55%  T4b: penetration or adhesion to adjacent organs

 caecum and ascending colon: ~20%

Nodal status (N)
o ileocaecal valve: 2%
 Nx: nodes cannot be assessed
 transverse colon: ~10%
 N0: no evidence of nodal involvement
 descending colon: ~5%
 N1a: involvement of one regional nodes
 N1b: involvement of 2-3 regional nodes

Staging  N1c: involvement of serosa or non-peritonealised pericolic/perirectal

tissues without regional nodal metastasis
 N2a: involvement of 4-6 nodes
Dukes (Astler-Coller modification)
 N2b: involvement of ≥7 mode
 stage A: confined to mucosa
 stage B: through muscularis propria Metastases (M)
 stage C: local lymph node involvement  Mx: presence of metastases cannot be assessed
 stage D: distant metastases  M0: no evidence of metastases
 M1a: distant metastases confined to one organ (e.g. liver, lung, ovary, non-
TNM staging regional node)
 M2b: distant metastases confined to more than one organ or to the
Primary tumour staging (T) peritoneum

 Tx: primary tumour cannot be assessed

 T0: no evidence of primary tumour
 Tis: carcinoma in situ
 T1: into (but not through) submucosa
 T2: into (but not through) muscularis propria
 T3
o through muscularis propria into subserosa, or