From the Guidelines
The most appropriate investigation for this 65-year-old male patient with a history of right hemicolectomy for cecal cancer who presents with abdominal pain, vomiting, and abdominal distension is option C: Colonoscopy, as it allows for direct visualization of the colon to identify potential obstructing lesions, anastomotic strictures, or recurrent cancer, and can also be therapeutic in some cases. This patient's presentation suggests possible bowel obstruction, which is a common complication following colorectal cancer surgery, as noted in the study by 1. Given his history of colon cancer, there is concern for recurrence or anastomotic stricture at the surgical site.
Key Considerations
- The patient's symptoms, including abdominal pain, vomiting, and abdominal distension, are consistent with a bowel obstruction, as described in the study by 1.
- Colonoscopy provides the best balance of diagnostic accuracy and therapeutic potential while being less invasive than surgery for this particular clinical scenario.
- Small bowel series or barium enema would be contraindicated in suspected obstruction as contrast material could worsen the condition, as noted in the study by 1.
- Laparotomy is too invasive as an initial diagnostic approach when less invasive options are available.
Diagnostic Approach
- The study by 1 highlights the importance of a thorough diagnostic approach, including clinical evaluation, laboratory tests, and imaging studies, to determine the underlying cause of the patient's symptoms.
- In this case, colonoscopy is the most appropriate initial investigation, as it can provide direct visualization of the colon and help identify potential obstructing lesions, anastomotic strictures, or recurrent cancer.
Therapeutic Options
- If an obstruction is found, colonoscopy can also be therapeutic, allowing for decompression or stent placement, as noted in the study by 1.
- The study by 1 highlights the importance of considering the patient's overall clinical picture, including their history of colon cancer, when determining the best course of treatment.
From the Research
Appropriate Investigation for Small Bowel Obstruction
The patient's symptoms of abdominal pain, vomiting, and distended but soft abdomen suggest a possible small bowel obstruction. The appropriate investigation for this condition is:
- Computed Tomography (CT) scan, as it is a powerful tool for assessing patients with small bowel obstruction 2, 3, 4, 5, 6
- CT can provide important information about the cause and site of obstruction, as well as the presence of a closed-loop obstruction or ischemia 2
- CT is considered the preeminent imaging modality for the initial evaluation of patients with suspected high-grade small bowel obstruction 4
- Other imaging modalities, such as plain radiographs, contrast imaging/fluoroscopy, ultrasonography, and magnetic resonance imaging, may also be used, but CT is usually the most appropriate and accurate diagnostic imaging modality 6
Options to Avoid
The following options are not the most appropriate investigations for small bowel obstruction:
- Small bowel series, as it plays a less significant role in the diagnosis of acute small bowel obstruction 4
- Barium enema, as it is not the primary imaging modality for small bowel obstruction 4
- Colonoscopy, as it is not typically used for the diagnosis of small bowel obstruction
- Laparotomy, as it is a surgical procedure and not an investigation, although it may be necessary in some cases of small bowel obstruction 2, 3