Large bowel obstruction due to diverticular stricture

Case contributed by Michael P Hartung
Diagnosis almost certain


Abdominal pain, nausea, vomiting.

Patient Data

Age: 55 years
Gender: Female

Diffuse dilation of the large bowel with scattered diverticula. Abrupt transition point in the pelvis in the mid sigmoid colon with a short-segment stricture with some associated wall thickening. Mild dilation of the small bowel as well. No adenopathy or suspicious findings elsewhere.

Case Discussion

This patient has a history of recurrent LBO due to a known diverticular stricture (confirmed on colonoscopy). Due to the nature of the recurrent obstructions, the patient was eventually treated with sigmoidectomy. When evaluating a stricture-causing LBO, think broadly about the possible causes - malignant and benign (diverticular, inflammatory, ischemic). Often there are supporting clues to help you favor one diagnosis over another. Diverticular strictures can have some thickening (as in this case) but should not have a mass-like appearance, and usually do not have enlarged lymph nodes associated. They also most commonly occur in the sigmoid colon, whereas malignant strictures (think apple core lesion) can occur throughout the large bowel.

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