Findings

The first CT colonoscopy image shows a 1.66-cm polyp (2b) in the ascending colon, approximately 203 cm from the rectum. Note also intestinal malrotation, with the small bowel occupying the right abdomen and the colon occupying the left abdomen. As a result, the cecum has a midline position.

The second CT colonoscopy image shows an additional 0.5 cm-polyp in the sigmoid colon.

Discussion

The patient was scanned using low-dose protocol on a 64-slice CT in both the prone and supine positions. The CT images immediately revealed the reason behind the difficulties experienced by the gastroenterologist. The patient exhibited intestinal malrotation, with the small bowel located in the right abdomen and the colon located in the left abdomen. If this condition has not been previously identified in a patient, it is impossible for the gastroenterologist to recognize it during an optical procedure.

Using CTC, we were able to demonstrate the exact size and location of the polyp (Figure 1) to the gastroenterological surgeon. The global view together with the 3D virtual endoscopy, with automatic size measurement, proved convincing tools for communication with our surgical colleagues. Additionally, we were able to identify another smaller lesion in the sigmoid colon which had not been identified in the optical examination (Figure 2).

This case clearly demonstrates the clinical benefit of "X-ray vision" for difficult anatomical cases. CTC gave us a clear picture of the entire anatomy and, using CT colonography, we were able to confidently guide the surgeons to a successful clinical outcome.