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Caecal tumour with hepatic metastases?
  1. S Rajendra1,
  2. K Kutty2
  1. 1Division of Gastroenterology, Department of Medicine, Royal Perak College of Medicine, Ipoh, Malaysia
  2. 2Department of Pathology, Sri Kota Hospital, Klang, Malaysia
  1. Correspondence to:
    Dr S Rajendra
    Division of Gastroenterology, Department of Medicine, Royal Perak College of Medicine, 3 Jalan Greentown, 30450 Ipoh, Malaysia;

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Clinical presentation

A 57 year old farmer presented with a four day history of jaundice, fever, chills, nausea, and right upper and lower quadrant pain. He had just returned from India a month earlier. There was no relevant past medical, surgical, family, or social history. Clinically, he looked wasted and had a temperature of 38.5°C. Tenderness was elicited in the right hypochondrium and there was a palpable tender colon in the right iliac fossa. Blood investigations revealed a raised erythrocyte sedimentation rate of 73 and abnormal liver function tests (bilirubin 47 μmol/l, alkaline phosphatase 314 U/l, gamma glutamyl transferase 263 U/l, aspartate aminotransferase 66 U/l, and alanine aminotransferase 108 U/l). Blood and urine cultures revealed no growth. Mantoux and human immunodeficiency virus testing was negative. Further serology for an infectious aetiology was sought.


How do the computed tomography scan of the abdomen and colonoscopy images help in the diagnosis (fig 1)?

Figure 1

 Computed tomography scan (A) and colonoscopy image (B) of the abdomen.

See page 200 for answer

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