Large bowel obstruction

Case contributed by Dr Henry Knipe

Presentation

Left sided abdominal pain with nausea/vomiting and constipation. Background of coeliac and diverticulitis.

Patient Data

Age: 40
Gender: Male
X-ray

Abdomen

Dilated loops of large bowel up until the sigmoid colon. Few air-fluid levels on erect projection. Gas is present in the rectum. Large faecal mass present in the caecum/ascending colon. This may represent a partial large bowel obstruction with a transition point in the sigmoid colon.

CT

Abdomen/Pelvis

Thickened segment of sigmoid colon with diverticulae. Pericolonic fat stranding which extends superiorly around the descending colon with associated prominent lymph nodes. Colon is dilated measuring up to 7 cm (transverse colon) and 10.5cm (caecum) up until the thickened sigmoid segment. Gas and faeces are present in the rectum. Small bowel is collapsed but appears unremarkable. No free gas or free fluid. Prominent mesenteric and para-aortic lymph nodes without lymphadenopathy by size criteria.

Conclusion: Thick walled segment of proximal sigmoid colon causing incomplete bowel obstruction. Associated with diverticulae regional fat stranding likely reflects coexistent diverticulitis. Malignancy cannot be excluded on this study. There are thick bands of soft tissue tethered to adjacent ileum and bladder dome, both of which are distorted.

Treating team requested a GG enema to assess level of obstruction. 

Fluoroscopy

GG enema

Administration of 60 mL of gastrografin via a rectal Foley catheter demonstrated a complete obstruction at the level of the sigmoid colon.

Case Discussion

Patient proceeded to theatre for colectomy. Histopathology demonstrated complicated diverticular disease with diverticulitis, abscess formation and luminal narrowing.

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Case information

rID: 27836
Case created: 22nd Feb 2014
Last edited: 5th Apr 2017
Inclusion in quiz mode: Included

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