Presentation
Pelvic pain with fever and leukocytosis. The ultrasound exam showed pelvic collection (? tubo-ovarian origin).
Patient Data
Small numerous diverticula of the sigmoid colon with thick enhanced wall. A focal perforation of the sigmoid wall (antimesenteric side) in continuity with an extraluminal air-fluid collection extending to the uterovesical space, measuring 10 x 6 x 4 cm with a thick enhanced wall, surrounding fat stranding and thickening of the adjacent peritoneal reflections. Thickening with the enhancement of the left fallopian tube may indicate reactive salpingitis. Minimal free peritoneal fluid is noted in the right pelvic region and Douglas pouch as well as small pelvic lymphadenopathy.
Left unilocular ovarian cyst (4 cm).
Small intramural leiomyoma (Figo 4).
Small umbilical hernia of intestinoepiploic content.
Annotated image showing the site of sigmoid perforation and the air-fluid collection in the uterovesical space.
Case Discussion
MRI features most consistent with perforated sigmoid diverticulitis with abscess formation in the uterovesical space.