Diverticular stricture

Case contributed by Dr Ian Bickle

Presentation

Barium examination several years earlier. Now presents with clinical suspicion of diverticulitis.

Patient Data

Age: 70 years
Gender: Female
Barium

A full barium examination with a complete set of images (various projections)

Diverticulosis of the sigmoid colon.

Moderate length tight stricture of the mid-distal sigmoid with irregularity of the mucosa.  No shouldering of the stricture ends.  Failure of luminal opening on all views consistent with a stricture.

Case Discussion

Diverticular disease is very common and accounts for a significant amount of surgical admissions with an acute abdomen in those over 50 years of age.

The sigmoid colon is the most common colonic segment to be involved.  In severe disease, especially after recurrent episodes of diverticulitis, a range of complications can occur one of which is a stricture.

This can pose a dilemma in distinguishing the difference between a malignant and inflammatory stricture, especially with disease overlap in this age group.

Traditionally barium enema has been performed although endoscopy is the first line assessment and CT colonography now overtaking from the radiological perspective.

The diverticular stricture is typically short-moderate in length, irregular, but without mucosal destruction, and lacks the shouldered edges observed in malignancy which give rise to the typical apple core appearance.

This stricture was investigated and no evidence of malignancy identified.   

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Case information

rID: 57961
Published: 25th Jan 2018
Last edited: 16th Jul 2018
Tag: rdgh
Inclusion in quiz mode: Included
Institution: Rotherham Foundation Hospital Trust

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