2026, Number 3
<< Back Next >>
Rev Fac Med UNAM 2026; 69 (3)
Radiologic apple-core sign associated with colon cancer
Maldonado LI, Lozano PHA, Rodríguez MCA, Reyes EC
Language: Spanish
References: 13
Page: 23-27
PDF size: 729.54 Kb.
ABSTRACT
The radiologic apple-core sign was initially described as the
“napkin-ring” sign in the first contrast enemas using bismuth
subnitrate at the end of the nineteenth century. It has become
relevant in medicine as an indicator of decreased intestinal
lumen caliber, demonstrating annular, filiform stenosis with
irregular margins due to a lesion causing thickening of the
colonic wall. This radiographic image reveals circumferential
luminal narrowing in a short segment of the colon, of unexpected,
rapid, and irregular onset, with asymmetry of the
mucosal pattern in the affected segment, ending abruptly
with restoration of the caliber and intestinal mucosal pattern.
Currently, the contrast enema procedure uses air and barium
as contrast agents and offers a sensitivity of 96% and a specificity
of 98% for detecting colonic obstruction. However, it is
contraindicated when active bleeding is suspected.
The apple-core sign is not a specific imaging finding;
however, it frequently corresponds to malignant tumors in
advanced stages. The most common neoplastic process of
the digestive tract is colonic adenocarcinoma, 50% of which
occurs in the rectosigmoid colon3. Several risk factors exist,
among which the presence of adenomatous polyps stands
out. Since colon cancers are responsible for 60–70% of colonic
obstructions, differential diagnosis and adequate clinical
correlation must be performed for timely intervention4.
The diagnosis of intestinal obstruction is clinical and manifests
as interruption of fecal evacuation and meteorism prior
to emesis5. On physical examination, a distended, soft,
depressible abdomen without signs of peritoneal irritation
is observed. If tumor-related obstruction is suspected, contrast-
enhanced thoracoabdominopelvic computed tomography
with and without intravenous iodinated contrast administration
should be performed whenever possible.
This
permits localization and diagnosis of the tumoral lesion, assessment
of extension such as hepatic, pulmonary, and peritoneal
carcinomatosis metastases, as well as visualization of
possible complications such as small bowel dilation, abscesses,
perforation, peritonitis, and proximal digestive ischemia7,8.
Surgical treatment will be determined according to the patient’s
general condition, based on the oncologic evaluation
of the disease, the extent of the cancer, and the location of
the tumor. Treatment should control the obstruction, which
constitutes a surgical emergency, and subsequently propose
cancer treatment whenever possible1.
REFERENCES
Claudio CA. Coronta de manzana: signo en radiologíagastrointestinal [Internet]. Rev Chil Radiol. 2009 [citado 2024 Abr 1]. Disponible en: https://scielo.conicyt.cl/pdf/rchradiol/v15n2/art08.pdf
Gulias Herrero A. Manual de terapéutica médica y procedimientosde urgencias [Internet]. México, D.F.: McGraw-Hill Interamericana Editores; 2016 [citado 2025 Feb 10].Disponible en: https://accessmedicina-mhmedical-com.pbidi.unam.mx:2443/content.aspx?sectionid=130560344&bookid=1846#130560365
Jooste V, Remontet L, Colonna M, Belot A, Launoy G,Binder-Foucard F, et al. Trends in the incidence of digestivecancers in France between 1980 and 2005 and projectionsfor the year 2010. Eur J Cancer Prev [Internet].2011;20(5):375-80. Disponible en: https://doi.org/bcc6kw
Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, ClavienPA, Demartines N. Systematic evaluation of surgicalstrategies for acute malignant left-sided colonic obstruction.Br J Surg [Internet]. 2007;94(12):1451-60. Disponibleen: http://dx.doi.org/10.1002/bjs.6007
Venara A, Barbieux J, Lermite E. Oclusión cólica por cáncer.EMC - Técnicas Quirúrgicas - Aparato Digestivo [Internet].2018;34(1):1-8. Disponible en: https://doi.org/q6hk
McArdle CS, McMillan DC, Hole DJ. The impact of bloodloss, obstruction and perforation on survival in patientsundergoing curative resection for colon cancer. Br J Surg[Internet]. 2006;93(4):483-8. Disponible en: http://dx.doi.org/10.1002/bjs.5269
Mang T, Bogveradze N, Bergman M, Leitner S, ScharitzerM. Imaging of colorectal cancer: role of computed tomographycolonography. Radiologie (Heidelb). 2025;65(6):416-25.doi:10.1007/s00117-025-01456-8. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12106516/
Lohsiriwat V. The influence of preoperative nutritional statuson the outcomes of an enhanced recovery after surgery(ERAS) programme for colorectal cancer surgery. TechColoproctol [Internet]. 2014;18(11):1075-80. Disponibleen: http://dx.doi.org/10.1007/s10151-014-1210-4
Argente HA, Álvarez ME. Semiología médica: fisiopatología,semiotecnia y propedéutica [Internet]. 2a ed. Madrid:Editorial Médica Panamericana [citado 2026 May 12]. Disponibleen: https://mieureka-medicapanamericana-com.pbidi.unam.mx:2443/viewer/semiologia-medica-1/791
Dragovich T, Tsikitis VL. Colon cancer [Internet]. MedscapeReference. Updated 2025 Feb 4 [citado 2026 May12]. Disponible en: https://tinyurl.com/22tvsg54
Instituto Nacional de Estadística y Geografía (INEGI).Estadísticas a propósito del Día Mundial contra el Cáncer[Internet]. Comunicado de prensa 39/25. 2025 Ene30 [citado 2026 Ene 11]. Disponible en: https://tinyurl.com/28q38ksv
Diaconescu M, Burada F, Mirea CS, Moraru E, CiorbagiuMC, Obleagă CV, et al. Colon cancer T4: current treatment.Curr Health Sci J. 2018;44(1):5-13. doi:10.12865/CHSJ.44.01.01. Disponible en: https://tinyurl.com/28wprtz8
Medina-Franco H, Suárez Bobadilla YL. Escrutinio y vigilanciadel cáncer colorrectal. Rev Gastroenterol Mex.2010;75(Supl 2):131-7.
Full text