Acute colonic diverticulitis

Case contributed by Mohammad Taghi Niknejad
Diagnosis almost certain

Presentation

Work up for acute left-sided abdominopelvic pain.

Patient Data

Age: 35 years
Gender: Female
This study is a stack
Axial With
oral contrast
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Axial C+
delayed
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal C+ portal
venous phase
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Info

Multiple diverticula are seen at the left hemi-colon, accompanied by segmental increased wall thickness at the sigmoid colon with surrounding fat stranding most consistent with acute diverticulitis. There are no signs of perforation, secondary abscess formation, and fistula formation.

Case Discussion

On imaging, colonic diverticulitis is characterized by segmental colon wall thickening with surrounding fat stranding and adjacent diverticula, usually in the sigmoid. Pericolic fat stranding is often disproportionately prominent compared to the amount of bowel wall thickening.

Extravasation of gas and fluid into the pelvis and peritoneal cavity suggests diverticular perforation. Abscesses and fistula formation (usually a chronic complication) may be seen in complicated cases.

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