Preoperative Assessment

The assessment of colon proximal to an obstructing colonic mass has been a shortcoming of conventional colonoscopy. In the past, inter-operative palpation or post-operative colonoscopy was performed with the possibility of a second surgery required for a missed synchronous cancer or adenoma. The sensitivity of hand palpation is fairly low and intraoperative insufflation of the colon increases the risk of peritoneal contamination.

Double contrast barium enema remains in the algorithm for work-up of colorectal cancer in evaluation of the proximal bowel in cases of an obstructing mass. This examination is not preferred, as the proximal colon often does not drain all of the barium by the time of surgery. Patients are also at increased risk for post-operative morbidity if a reactive peritonitis develops secondary to barium contamination intra- operatively.

The incidence of synchronous neoplasia in the colon has been described at a rate of 1.5-9%. Adenomas harboring in the colon in patients with colon cancer have been reported at an incidence of 2755%. Fenlon et al. compared CTC to pre-operative double contrast barium enema in the evaluation of patients with an obstructing carcinoma (Fenlon et al. 1999a). CTC identified all of the cancers including 2 synchronous cancers proximal to the obstructing mass that were missed by barium enema (Fenlon et al. 1999a). In addition, CTC demonstrated 16 of 18 polyps in the proximal colon.

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