Extracolonic findings in patients undergoing abdomino-pelvic CT for suspected colorectal carcinoma in the frail and disabled patient.

AIM: The aims of this study were to evaluate the extracolonic findings identified in patients undergoing minimal preparation abdomino-pelvic CT in place of barium enema or colonoscopy for the detection of possible colorectal carcinoma.

MATERIALS AND

METHODS

The CT technique involved helical acquisition (10 mm collimation, 1.5 pitch) following 2 days of preparation with oral contrast medium only. Extracolonic findings were evaluated in the light of subsequent follow-up and accuracy. The evaluation included assessment of the potential contribution of the extracolonic finding(s) to staging the cancer in the subset of patients who had colorectal carcinoma, and to account for the patients' presenting symptoms and signs in the remaining patients.

RESULTS

A total of 344 extracolonic findings were detected in 261 CT examinations, from amongst a total of 1077 cases (24%). Extracolonic findings were potentially important in staging in 32 of the 98 (33%) cases subsequently found to have colorectal cancer. There were 284 extracolonic findings amongst the 221 cases who proved not have colorectal cancer. One hundred and twenty-four (44%) of these 284 findings were actively followed up by clinicians, and 33 (12%) ultimately had a surgical intervention. Fifty-six percent (160/284) of the findings were determined to be correct (by further investigation, autopsy, and/or clinical follow-up); the remainder were incorrect or indeterminate (n = 56) or had no follow-up (n = 68). The commonest extracolonic findings were focal liver lesions (found in 42/1077, 4%) and abdominal aortic aneurysms (31/1077, 3%). Twenty-four (24/1077, 2%) previously unknown extracolonic malignancies were detected. Ten percent (106/1077) of the patients had extracolonic findings that could potentially have accounted for their presenting symptoms.

CONCLUSIONS

CT has the added benefit, compared with colonoscopy and barium enema, of not just evaluating the colon but also of detecting extracolonic abnormalities. Such findings may be useful in staging the cancer, may explain the patient's presenting symptoms, and may detect other potentially serious disorders.