A Case Report of a Large Bowel Obstruction and Associated Closed-Loop Small Bowel Obstruction Secondary to Diverticular Disease

Diverticular disease is one of the most common gastrointestinal pathologies, and its prevalence is rising in areas where diets are low in fiber and high in processed foods containing preservatives and emulsifiers. While this commonly affects the colon, in rare cases, chronic diverticulitis can lead to scarring and fibrosis that impact the small bowel. This case report describes the clinical course of a 56-year-old male with multiple comorbidities who presented to the emergency department for acute abdominal pain with worsening abdominal distention. Imaging revealed extensive intraperitoneal free air, and he was emergently taken for an exploratory laparotomy. Surgery revealed feculent peritonitis, multiple bowel perforations, and a closed-loop small bowel obstruction between the tethered area of pelvic adhesions and a large bowel obstruction extending from the ileocecal valve to the stricture in the distal large bowel. This report highlights the uncommon presentation of simultaneous small and large bowel obstructions originating from related but distinct mechanisms, and emphasizes the importance of understanding how chronic diverticulitis can lead to significant and life-threatening complications. It emphasizes the need to identify causes of bowel ischemia and illustrates the critical role of a multidisciplinary team in managing complex postoperative complications and maintaining nutritional status in patients with significant comorbidities.