Acute perforated diverticulitis

Case contributed by Dr Jeremy Jones

Presentation

Right iliac fossa pain and localized guarding. Possible perforated appendicitis.

Patient Data

Age: 65
Gender: Female

Plain films - in emergency department

X-ray

Acute perforation with gas under the right hemidiaphragm. Non-specific bowel gas pattern. No obstruction.

Subsequent CT scan prior to theater

CT

Acute perforated diverticulitis with a pericolonic abscess anterior to the sigmoid colon.

Case Discussion

Acute diverticulitis has numerous complications including perforation, abscess formation and fistulation to adjacent structures, e.g. bladder and uterus.

it is important to recognize that not all right iliac fossa pain is appendicitis and that pre-operative CT is helpful for the surgeon, especially when in cases of atypical appendicitis or where the patient is outside the normal demographic.

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