Large bowel obstruction secondary to stenosing diverticular disease

Case contributed by Dr Henry Knipe

Presentation

Vomiting and abdominal pain.

Patient Data

Age: 80 years
Gender: Male
Marked large bowel dilatation with cecum measuring up to 8.6 cm. Transition to collapsed bowel at the proximal sigmoid colon where there is a 3.0 cm stenosing lesion. Background of uncomplicated colonic diverticular disease. Hyperdense colonic contents, has the patient had recent enteric contrast? Pericolonic fat stranding and fluid around the ascending colon and cecum. No free gas. No enlarged lymph nodes.

Case Discussion

The patient proceeded to colectomy.

Histopathology

MICROSCOPIC DESCRIPTION:

Sections show numerous outpouchings of the colonic mucosa extending deeply, through the muscularis propria.  There is frequently a surrounding cuff of lymphocytic inflammation including secondary follicles. The stricture shows marked fibrosis and distortion. No suppurative inflammation or perforation is identified.  The bowel wall at the edge of the defect described macroscopically is viable (suggesting surgical artefact), as are the resection margins.  There is no evidence of malignancy.

DIAGNOSIS:

Sigmoid colon resection and completion colectomy:  Widespread diverticular disease with a stricture in the sigmoid colon.

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