Acute colonic obstruction: Do not forget diverticular disease!

P. Bucher, A. Carecchio

Objective

Diverticular stenosis is a complication of diverticular disease. While its frequency is decreasing owing to improved patient care and follow-up it remains an infrequent indication to sigmoïdectomy. But infrequently diverticular stenosis may present as acute and severe colonic occlusion.

Methods

We here review two recent cases of severe acute colonic occlusion due to diverticular stenosis. We review these cases approach, treatment and iconography in an effort to enlighten what could help the surgeon to suspect the correct diagnosis pre-operativelly when emergency prevent endoscopic or radiological work-up to elucidate the differential diagnosis of colonic stenosis and occlusion.

Results

Two patients were admitted for acute abdomen in relation with severe acute colonic occlusion, all two with signs of sepsis. Emergency computed tomography scanner showed short and well defined sigmoïd stenosis with enlarged bowel wall. One was located at the colo-rectal junction and the second in the mid-sigmoïd segment. None of them had a clear history of previous acute diverticulitis. Surgical exploration requested an open approach due to severity of bowel distention. In none of these case peri-operative diagnosis of diverticular stenosis, exclusion of cancer, could be achieved before opening of the resected segment, implying to performed in all a first intention oncologic resection. Owing to the absence of oncologic disease, primary handsewn colorectal anastomosis were performed. No complication, especially anastomosis dehiscence were recorded. All patient had post-operative colonoscopy, at 6 weeks, which show absence of polyps.

Conclusion

Acute sigmoïd colon occlusion may be a diagnostic challenge when emergency surgery is indicated. Absence of pre-operative diagnosis request that the surgeon performed an oncologic resection, as until proved the stenosis should be considered as malignant. But as confirmed by these observations: diverticular stenosis still exist and may present as acute occlusion.