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.