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  1. 1. MULTIDISCIPLINARY TEAM MEETING SURGICAL UNIT -1 JINNAH HOSPITAL LAHORE DATED : 17/01/23
  2. 2. CASE SUMMARY • Patient Rafique 51 Y/M ,tailor by profession, non diabetic non hypertensive ,smoker presented in OPD with c/o Fecal discharge per urethra- 2 years Lower abdominal pain - 2 years • O/E Mild tenderness in left iliac fossa ,no mass palpable, no lymphadenopathy appreciable , • DRE : normal anal tone with normal prostate examination, proctoscopy internal opening at 12 o clock position ,
  3. 3. • Primary internal hemorrhoid at 3 o clock position • Past Surgical : no previous hx of abdominal surgery • Past Medical : Smoker , hypertensive
  4. 4. USG KUB (05/10/22) • Ultrasound abdomen showed right renal calculi , Vesical calculi and cholelithiasis.Urinary bladder showed thick calcific specs.no lymphadenopathy noted
  5. 5. CT ABDOMEN PELVIS( 01/12/22) • Circumferential enhancing thickening of sigmoid colon with multiple diverticula and colovesical fistula suggestive of acute sigmoid diverticulitis.Fat planes between the lesion and bladder not preserved with thickening of the bladder measuring 6.6mm. There is adjacent fat stranding and subcentimetric lymphadenopathy. Left paraaortic and left common iliac nodes appreciated.
  6. 6. COLONOSCOPY (13/12/22) • Large polypoidal growth 13cm from anal verge involving three fourth of the circumference of gut . Multiple diverticular openings below the growth identified . Biopsy of growth taken.
  7. 7. BIOPSY REPORT (23/12/22) • Colonic mucosal fragments with architectural distortion of glands and mild to moderate acute and chronic inflammation .no dysplasia or malignancy noted .
  8. 8. RETROGRADE URETHROGRAM • Strictural narrowing of posterior urethra and proximal bulbar urethra with no flow of contrast seen into the urinary bladder.

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