Large bowel obstruction - stricture secondary to diverticular disease

Case contributed by Dr Henry Knipe

Presentation

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

Patient Data

Age: 40 years
Gender: Male

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

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 (cecum) up until the thickened sigmoid segment. Gas and feces 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. 

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 theater for colectomy. Histopathology demonstrated complicated diverticular disease with diverticulitis, abscess formation and luminal narrowing.

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Case information

rID: 27836
Published: 10th Mar 2014
Last edited: 19th May 2019
Inclusion in quiz mode: Included

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