Investigation

- CBC

Blood Chemistry Coagulogram Endoscope Biopsy Film abdomen

Lab result
CBC WBC 7,100 RBC 3,910,000 Hb 12.3 HCT 36.7 MCV 93.8 RDW 13.2 PLT 220000 Neutrophil 73 Lymphocyte 20 u/L u/L g/dL % fL % u/L

Blood Chemistry
BUN Creatinine Na K Cl CO2 18 mg/dl 0.9 mg/dl 135 mEq/L 3.4 mEq/L 99 mEq/L 24 mEq/L

Coagulogram
PT INR PTT APTT Ratio 11.9 sec 1.02 12.50 sec 0.86

Endoscope Circumferential mass at desending colon nearly obstruction , biopsy was done 9 cm SEM stent was insert over guide wine under flue Endoscopic diagnosis : CA desending colon Procedure : colonic stent

Biopsy
Summary of clinical information : CA desending colon Gross examination : CA desending colon consist of four piece of light soft tissue ,ranging from 0.1-0.3 cm in diameter section Microscopic examination : section show 3 pieces of colonic mucosa that show malignant cell s having mild to moderate pleomorphic nuclei and cuboid to columnar cytoplasm. They form glands and cribiform pattern infiltrate submucosa

Diagnosis : desending colon, biopsy, moderate differentiated adenocarcinoma

Film abdomen
Small bowel dilation with air fluid level

Lab discussion
-Film abdomen : Small bowel dilation with air fluid level
Small bowel obstruction perforation

-CBC : -Electrolyte : -Coagulogram :