Obstructive colonic diverticular stricture
Abdominal pain, nausea, and vomiting
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Diffuse dilation of fluid-filled small and large bowel. Transition point in the distal descending/proximal sigmoid colon, with some minor wall thickening and irregularity. Few small sigmoid divertciula.
Small and large bowel obstruction due to a benign colonic diverticular stricture (confirmed by endoscopic biopsy and pathologic specimen). The appearance is actually most concerning for a malignant stricture, as on the coronal images there appears to be thickened enhancing soft tissue near the proximal transition point - specifically a scirrhous type of adenocarcinoma. The next appropriate step for this patient is to have a gastroenterology consultation, who can consider a diagnostic (biopsy) and therapeutic (stent) colonoscopy, which was done in this case confirming a benign diagnosis and placing a temporary stent to relieve the obstruction.