Diverticular Stricture

A diverticular stricture results from chronic inflammation and fibrosis of the sigmoid colon, producing fixed luminal narrowing.

It may cause partial or complete large bowel obstruction and can be difficult to distinguish from colorectal carcinoma.

The inability to exclude malignancy is itself an important reason for oncological style resection.

Patients develop progressive constipation, altered stool calibre, abdominal distension and intermittent left lower abdominal discomfort.

High grade obstruction produces absolute constipation, distension and vomiting.

Weight loss, anaemia or rectal bleeding increase concern for malignancy but cannot reliably distinguish cancer from benign inflammatory stenosis.

CT abdomen and pelvis: define the length and severity of narrowing and identify proximal obstruction.

Colonoscopy with biopsy: attempt after acute inflammation settles if the narrowing can be traversed safely.

A benign biopsy does not completely exclude an infiltrative malignancy when the stricture itself cannot be adequately assessed.

A symptomatic diverticular stricture generally requires sigmoid colectomy.

Resect the entire diseased sigmoid and anastomose healthy proximal colon to healthy rectum.

Treat the specimen with oncological principles when malignancy cannot be confidently excluded, including adequate lymphovascular resection and avoidance of tumour disruption.

Endoscopic balloon dilation or long term stenting is generally inappropriate for an unexplained diverticular stricture because of perforation risk, recurrence and the possibility of occult cancer.

Complete obstruction, threatened perforation or physiological deterioration requires urgent intervention.

A stable obstructed patient may undergo resection with primary anastomosis when bowel and physiology are favourable. Major contamination, poor perfusion or severe instability may require staged surgery.