This was 61 year old gentleman ,who came for complaints of  right upper quadrant pain , poor appetite for the past 1 month. He also gave history of tenesmus later in the day ( after a normal evacuation in the mornings ) . There was no history of any malaena.

His liver showed multiple secondaries .

Clinically he had uncontrolled systemic hypertension and mildly elevated s. creatinine of 1.7 mgms/dl.

The diagnosis offered was multiple liver secondaries with incidental finding of shrunk right kidney with probable reduced function.

DISCUSSION : Generally the target sign or the bird’s eye view of the Mexican hat sign could signify colo-rectal carcinoma.

Further investigations revealed normal upper G.I. Endoscopy .

Colonoscopy revealed  Carcinoma of Rectum with no obstruction.

He has been advised chemo-radio therapy by the surgeon.