BMJ Case Reports 2011; doi:10.1136/bcr.07.2010.3196
  • Reminder of important clinical lesson

An unusual case of fever and a sigmoid mass

  1. Michael Saunders1
  1. 1Department of General Surgery, Barnet Hospital, Herts, UK
  2. 2Department of Surgery, Barnet and Chase Farm Hospitals, Herts, UK
  1. Correspondence to Dr Mio Takatsuka, miotakatsuka{at}


A 52-year-old Afro-Caribbean female presented with a 2-week history of left iliac fossa pain and persistent fever. The working diagnosis was diverticulitis and she was treated with intravenous antibiotics. A CT scan of the abdomen showed a thickened sigmoid colon lying adjacent to the left bladder wall with inflammatory changes present. As the patient’s condition showed no improvement, an explorative laparotomy was performed, which identified a mass in the sigmoid colon adherent to the bladder and left ovary. An anterior resection, partial cystectomy and a defunctioning loop-ileostomy were performed. Postoperatively, spiking fever with a high white cell count continued. No postoperative surgical complications were identified despite numerous investigations. Eventually, histology of the colon revealed a null type anaplastic large cell lymphoma with a high proliferation fraction of greater than 90%.


  • Competing interests None.

  • Patient consent Obtained.

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