Mural colonic abscess and colitis pattern. Potential underlying colonic neoplasia.
Concurrent chronic active pancreatitis.
I recommend surgical exploratory in this patient with expectations towards resection of the proximal colon. The colonic abscess appears to be localized between the submucosal layer and serosa occupying the muscularis. The lumen does not appear to be involved. The lesion measures approximately an inch in length. Resection of approximately 4.0 inches of the colon would be recommended. The opposite side of the cyst or abscess appears to have a thickened wall with some loss of detail. Biopsy of this region is recommended as well as full resection. Intraoperative ultrasound, resection, and anastomosis would be ideal in this case to ensure that complete resection of the mural pathology and optimal anastomosis with healthy tissue would be obtained. In the meantime, treatment for pancreatitis is recommended. Abscess culture would be recommended. If surgery is not an option then ultrasound guided drainage of the colonic abscess could be considered with aerobic and anaerobic cultures. I am very concerned for Clostridium perfringens and enterotoxin involvement in this case as a potential. Therefore, antibiotics should cover this potential with Enrofloxacin and Clindamycin combination. However, the best option for this patient is colonic resection and anastomosis and anastomosis of the mid descending colon with the distal ileum may be the best option in this case with concurrent treatment for pancreatitis. No overt evidence of metastatic disease was noted. My gut feeling is that this is a chronic inflammatory event with a mural abscess. However, underlying colonic carcinoma is a potential.