Radiation stricture and large bowel obstruction

Case contributed by Dr Jeremy Jones

Presentation

Admitted with worsening abdominal pain, faeculant vomiting and abdominal distension. History of hysterectomy and chemoradiotherapy for a gynaecological malignancy in the past.

Patient Data

Age: 90
Gender: Female

Large bowel obstruction with distended colon and a transition point in the descending colon

Large bowel obstruction with a smooth distal sigmoid stricture causing complete obstruction. Secondary area of bowel wall thickening in the descending/proximal sigmoid colon but not peri-colonic inflammatory changes.

Case Discussion

The large bowel obstruction that was evident on the plain films is confirmed at CT.  The transition point is deep within the pelvis and takes the form of a smooth 4cm long stricture.  There is no mass or features that suggest malignancy. 

A secondary area of abnormality is noted within the descending/proximal sigmoid colon.  It has wall thickening and some narrowing, but is not causing the obstruction and again, looks inflammatory.

Relative incompetance of the ileocaecal valve with partial decompression of the large bowel which still measures 7 cm at points.

Hysterectomy and bilateral oophorectomy noted.  The vaginal vault sits adjacent to the smooth stricture.  No nodal disease or features suggesting metastasis.

On balance, the stricture was considered benign and though to be secondary to the previous radiotherapy that the patient received for her hynaecological malignancy 10 years previously.

Diagnosis

Radiation induced sigmoid stricture with large bowel obstruction.

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Case information

rID: 14223
Case created: 8th Jul 2011
Last edited: 19th Nov 2015
Inclusion in quiz mode: Included

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