Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Large bowel obstruction secondary to malignancy occurs in 15% of patients diagnosed with colorectal cancer. While evidence of a lesion on CT may be pathognomonic of malignancy, it frequently has highly overlapping features on CT with diverticulitis. Acute diverticulitis, although associated with numerous complications, rarely causes large bowel obstruction. However, several case reports implicate chronic inflammation playing a larger role. In acute diverticulitis, inflammatory cells breach the integrity of the wall to cause perforation, fistulization and rarely obstruction. Although fistulization is not uncommon, there are few reports describing organ adherence due to chronic inflammation without CT evidence of a fistula. In chronic diverticulitis, fibrosis of the muscularis could be a predisposing factor to obstruction, as it causes bowel stenosis. This report describes a 67-year-old female, presenting with large bowel obstruction, and a sigmoid lesion reported on CT. Initial sigmoidoscopy revealed significant narrowing of the lumen, without evidence of a mass or inflammation. Patient underwent decompression and surgical resection of the lesion. Pathology revealed a focal area with acute and chronic diverticulitis and abscess with ovarian tissue and fallopian tube adherent to the serosal surface. This case suggests the cause of above presentation to be dual: chronic inflammation causing muscularis fibrosis and nearby organ adherence as well as acute inflammation with abscess formation causing bowel edema and further decrease in luminal diameter. Therefore, in a patient with chronic constipation and diverticular disease such constellation of events could significantly predispose them to obstruction and increase in mortality

Biography

Karolina Siniakowicz has obtained her Medical degree from Touro College of Osteopathic Medicine in New York City. She has extensive research experience, ranging from topics of diabetes mellitus to neurodegenerative disease, and has co-authored many publications prior to entering the field of Medicine. She is currently pursuing her Residency in Internal Medicine, and aspires to enter Gastroenterology Fellowship in 2018.