Presentation
Acute onset of pain in the left abdomen with guarding and moderately elevated leukocyte count. Because lack of cause and persistent complaints, an abdominal CT was ordered.
Patient Data
Axial slices through the upper abdomen. There are outpouchings (diverticula) on the mesenteric side of duodenum and jejunum, filled with contrast and/or air. These are better appreciated when viewing them on successive slices. On the left side, some fat stranding and focal free air are visible, caused by a perforation of one of the diverticula (so-called "sealed" perforation).
Selected slice highlighting:
- diverticulum = blue arrow
- free gas = yellow arrow
- fat stranding = red arrow
Case Discussion
A healthy male presents at the emergency department with acute abdominal pain and guarding in the left hemiabdomen. He had no fever and no other symptoms. On physical examination, there was tenderness and local guarding.
Lab results showed no abnormalities other than mildly elevated leukocyte count and C-reactive protein. Standing chest x-ray showed no free air.
Case supervised and validated by Dr Erik Ranschaert
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