Sigmoid stricture at colonoscopy--an indication for surgery

Strictures of the sigmoid colon continue to pose a diagnostic dilemma. They commonly appear to be due to diverticular disease but carcinoma must always be excluded. In some cases diverticula may be present but in others there is no obvious cause for the stricture. In a series of 1039 consecutive colonoscopies performed between 1984 and 1986, 19 cases of sigmoid stricture that could not be negotiated with the colonoscope were encountered. In each case the cause of the stricture could not be demonstrated. Fifteen patients (79%) underwent laparotomy primarily on clinical grounds or with barium enema findings suggestive of carcinoma. A final diagnosis of diverticular disease was made in nine cases and adenocarcinoma is six cases. Barium enema was a poor predictor of malignancy in a stricture. Four patients were treated conservatively and two of these patients continued to have significant symptoms due to diverticular disease. This experience suggests that sigmoid strictures that prevent the passage of a colonoscope should be resected when the cause of the stricture is not apparent.