Despite this treatment he continues to worsen with increasing bloody diarrheal stools. He is accustomed to having three to four slightly bloody stools per day but has had no bowel movements over the last three days. Physical exam reveals the patient to be obtunded, febrile and with a distended tender abdomen. Abdominal series reveals the transverse colon to be dilated to 10 cm. An upper GI series reveals a string sign in the medilium.
Colonoscopic biopsy reveals several foci of adenocarcinoma in the left colon.
The lowest lesion is noted 4 cm above the anal verge. An upper GI study reveals an enterocutaneous fistula. Physical exam is consistent with acute appendicitis. He is taken to surgery and a normal appendix identified. The only intraoperative finding is a markedly inflamed terminal ileum and the diagnosis of acute regional enteritis is made.