Differential Diagnosis of Colonic Strictures: Pictorial Review with Illustrations from Computed Tomography Colonography

Rare case of rectosigmoid stricture causing transverse colon volvulus

A 60-year-old woman with remote history of sleeve gastrectomy presented with altered mental status after an unwitnessed fall. She was found to be hypothermic with lactic acidaemia, leucocytosis, positive urinalysis, and dilated ascending and transverse colon on cross-sectional imaging, initially thought to be secondary to faecal loading. She was admitted to the medical intensive care unit for resuscitation and broad-spectrum antibiotics for presumed urinary sepsis. She became acutely altered and underwent urgent flexible sigmoidoscopy by gastroenterology to evaluate for ischaemic colitis. During the procedure, there was concern for iatrogenic colon injury given the friability of the colonic mucosa, so the patient was taken urgently for exploratory laparotomy. Intraoperatively, she was found to have a transverse colon volvulus with large areas of patchy, gangrenous bowel without evidence of gross perforation. A rectosigmoid stricture with associated serosal tear, but no full-thickness injury was identified. An extended left hemicolectomy and end transverse colostomy was performed resulting in improvement in the patient's clinical status and eventual discharge to subacute rehab.

Colonic strictures in children and young adults with Crohn's disease: Recognition on MR enterography

OBJECTIVES

Identify MRE features of colonic strictures in children/young adults with Crohn's disease.

METHODS

Included are patients with colonic strictures on colonoscopy imaged with MRE. Bowel wall thickening (BWT) with luminal narrowing, pre-stenotic dilatation (PSD), bowel wall enhancement, and diffusion restriction were evaluated.

RESULTS

All potential strictures (n=12) had BWT with luminal narrowing on MRE. 8/12 had PSD, meeting our MRE stricture criteria. MRE diagnosed 8/12 colonic strictures compared to colonoscopy but was concordant with findings in all surgical patients.

CONCLUSION

Strictures on MRE did not always agree with colonoscopy, but when correlating with surgery, MRE findings were all concordant.