S3784 Diverticulitis-Induced Sigmoid Stricture Causing Large Bowel Obstruction in a Young Adult

Introduction: Diverticulitis can clinically present with abdominal pain, nausea, vomiting, bloating, and a change in bowel habits. Chronic inflammation from repeated episodes of diverticulitis can lead to the development of colonic strictures. We present an uncommon case of a sigmoid colon stricture caused by diverticulitis in a young patient leading to large bowel obstruction and subsequent hemicolectomy. Case Description/Methods: A 49-year-old man with no significant past medical history presented to the emergency department with 3 weeks of diarrhea, intolerance to oral intake, and abdominal bloating/discomfort. He has no surgical history and denies history of smoking. He self-medicated with amoxicillin for 2 weeks without symptom improvement. He has never had a colonoscopy. On arrival, he was tachycardic to the 120s which improved after intravenous fluids. Initial labs were significant for leukocytosis at 12.91 cells/µL with a normal metabolic panel. Computed tomography of the abdomen/pelvis showed a 12 cm length of the distal descending colon/proximal sigmoid colon with significant circumferential wall thickening up to 2.4 cm and surrounding stranding concerning for a neoplastic process with colonic obstruction. Colonoscopy revealed a stricture measuring 10 cm in the sigmoid colon consisting of benign appearing tissue along with inflammatory appearing polyps. There was evidence of diverticulosis throughout the length of the stricture. The patient underwent a robotic left hemicolectomy with colorectal surgery for definitive treatment of the colonic obstruction. Discussion: Diverticulosis and diverticulitis is more common in older adults but may also affect younger populations. Risk factors for developing diverticulosis includes obesity, low-fiber diet, sedentary lifestyle, red meat consumption, use of nonsteroidal anti-inflammatory drugs, and smoking. Recurrent episodes of diverticulitis can lead to the development of fibrotic tissue or scarring in the colonic lumen which can form strictures. Diverticular strictures can lead to partial or complete bowel obstructions and can be difficult to distinguish from colorectal carcinoma on imaging. Our case demonstrates a unique case of extensive diverticulosis with diverticulitis seen in a young patient leading to a stricture and large bowel obstruction. Providers should include diverticular strictures in their differential for younger patients presenting with obstructive symptoms, especially when imaging mimics malignancy.