EP349 - When the Going Gets Tough: Large Bowel Obstruction Associated with Diverticulitis

Purpose/Background: Diverticulitis-associated large bowel obstruction (DLBO) is a rare presentation of diverticular disease. It may be due to stricture causing mechanical blockage or functional obstruction without luminal obstruction. Existing literature on DLBO is scarce; most studies focus on radiographic or diagnostic features rather than clinical presentation, management, or patient outcomes.

Methods/Interventions: A single institution, retrospective case series, and survey of patients with CT evidence of DLBO was conducted from 2019 - 2025. Patients were identified via review of departmental operative logs. Following chart review, patients were contacted via telephone for assessment of current quality of life using the diverticulitis quality of life (DV-QOL) and low anterior resection syndrome (LARS) score questionnaires.

Results/Outcomes: 23 patients with DLBO were identified, 48% were male, the mean age at presentation was 64 (40-87) years. 78% of patients with DLBO had documented prior treatment for diverticulitis in the hospital record, with a median of 3 prior episodes per patient. Prior to admission with DLBO, patients had a median of 4 days of acute symptoms and 42 days of chronic symptoms. Of the 18 patients who had undergone a previous colonoscopy, the median time from colonoscopy to admission was 20.5 months. Median follow-up time was 8 months (IQR 4 - 17) with one patient deceased by the time of follow-up.

On presentation, 100% of patients had CT evidence of LBO. 10(43%) patients had a water-soluble enema (WSE), with 2 patients demonstrating obstruction on this study. 9(39%) patients had a flexible sigmoidoscopy, with only 2 patients found to be endoscopically obstructed. Of the 6 patients with both WSE and endoscopy, no patients were obstructed on both studies. 10(43%) patients were taken to surgery following CT scan without WSE or flexible sigmoidoscopy.

All patients in the study population required operative intervention. 21(91%) patients underwent fecal diversion. 11(48%) underwent diverting loop colostomy, 7(30%) Hartmann's resection, 2(9%) sigmoid resection with anastomosis and fecal diversion, 2(9%) sigmoid resection with anastomosis without diversion, 1(4%) patient underwent total abdominal colectomy and end ileostomy. 12(57%) patients with fecal diversion had their stoma reversed during the follow-up period, with a median time to stoma reversal of 5.7 months. The median number of operative interventions per patient was 2(range 1-4). Of the 18 patients with eventual sigmoid resection, pathology demonstrated diverticulitis.

15(68%) patients participated in the telephone questionnaire. 80% of patients reported prior episodes of diverticulitis, with an average of 8.4 episodes reported. Median DV-QOL scores were 0.3, with 2 (13%) patients' scores exceeding 3.2, indicating clinically meaningful diverticulitis symptoms. Of the patients with restored intestinal continuity (n=9), the median LARS score was 2.

Conclusion/Discussion: In our institution, the majority of patients with DLBO had prior admissions and treatment for diverticulitis. Before their acute presentation, patients reported a median of 42 days of subacute obstructive symptoms. All patients required operative intervention for DLBO, 91% of patients required fecal diversion. 57% of patients with a stoma had restoration of intestinal continuity. Overall, post-operatively, patients had low DV-QOL and LARS scores, indicating that most patients did not have long-lasting diverticulitis symptoms or lower GI functional changes.Table: Study Data Overview
Descriptive analysis for the study cohort