Acute diverticulitis

Case contributed by Dr Rafael Lourenço do Carmo

Presentation

Patient presenting with left sided abdominal pain evolving for a few hours. Known history of colonic diverticular disease.

Patient Data

Age: 54 years
Gender: Female
CT

CT shows multiple diverticula in all colonic segments, associated with acute signs of acute inflammation of the sigmoid segment, namely wall thickening and enhancement, and marked stranding of the adjacent fat tissues. A small, pericolic fluid collection, with peripheral contrast enhancement is also seen in the proximal portion of the sigmoid, suggesting initial abscess formation.

Non-related findings are hepatic perfusion defect in segment IVb, right kidney calculi and bilateral silicon breast protheses. Metallic clips are seen in the gallbladder fossa following cholecystectomy. Incidental small appendicolith in the base of the appendix.

Case Discussion

Colonic diverticular disease is very common entity to be found in the elderly population. It affects 5% - 10% of the population over 45 years, and 80% of population over 80 years. Diverticula can be seen in all colonic segments, however they are much more often found in the sigmoid 1.

Acute diverticulitis is a colonic and pericolonic inflammatory condition, caused by obstruction of the diverticulum neck by stool, inflammation of food particles 1.

Most common CT findings are pericolic fat stranding, sometimes disproportionately prominent compared to the wall thickening and enhancement of the colonic wall.

Complications can also be seen in the CT, represented by extraluminal liquid or gas, suggesting perforation, abscess and/or fistula formation.

Treatment varies with presentation.

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Case information

rID: 50702
Case created: 18th Jan 2017
Last edited: 19th Jan 2017
Inclusion in quiz mode: Included

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