21st July 2023

A 79-year-old woman presents to the emergency department with a 12-hour history of recurrent vomiting

A 79-year-old woman presents to the emergency department with a 12-hour history of recurrent vomiting. This follows a week of worsening abdominal pain and distension, and reduced frequency of bowel motions, now only passing stool once a week. An abdominal x-ray shows large bowel obstruction. She undergoes a CT abdomen and pelvis which unfortunately shows a lesion that is suspicious for a primary malignancy at the transition point of her bowel obstruction with evidence of extra-luminal metastasis.

Given her likely diagnosis, what is the most common site of metastasis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.