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PICTORIAL ESSAY   

Journal of Radiological Review 2020 July-August;7(4):279-91

DOI: 10.23736/S2723-9284.20.00040-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Non-obstructive emergency presentations of colorectal carcinoma: computed tomography findings and differential diagnosis

Massimo TONOLINI 1, Sergio MARGARI 2 , Antonio G. OLIVA 1, 2

1 Department of Radiology, L. Sacco University Hospital, Milan, Italy; 2 Department of Radiology, Fatebenefratelli Hospital, Milan, Italy


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Despite screening programs, nowadays a significant proportion (20-25%) of colorectal carcinomas (CRCs) is still diagnosed in advanced neoplastic stages, usually in the emergency department. Whereas bowel obstruction accounts for the vast majority (over 80%) of acute presentations, less common acute complications of CRC include: 1) perivisceral abscess formation; 2) perforation into the peritoneal cavity or the retroperitoneum; 3) fistulization to the other abdominal and pelvic organs, the abdominal wall and the skin. Albeit rare (2-2.5% of surgically treated CRCs), these non-obstructive emergency presentations represent challenging situations from the clinical, surgical and oncological perspectives. After reviewing the recent literature concerning incidence, pathogenetic mechanisms, clinical features, surgical issues, this paper presents our experience (clinical records over 9 years) in the diagnosis and treatment of colorectal emergencies. The main and ancillary computed tomography (CT) findings of abscess-forming, perforated and fistulizing CRC are presented, with an emphasis on imaging interpretation technique and differential diagnosis. Since patients with acute abdominal complaints routinely receive urgent CT, our main purpose is to help radiologists on duty at the emergency department in providing a quick and correct diagnosis of non-obstructive acute CRC complications, which is crucial to direct appropriate treatment and ultimately to improve the long-term prognosis.


KEY WORDS: Colorectal neoplasms; Abscess; Fistula; Tomography, X-ray computed

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