Presentation
Abdominal distension, abdominal pain and constipation for one week. Associated with low grade fever.
Patient Data
Air-filled large bowel loops which are slightly prominent, but within normal diameter.
No dilatation of small bowel loops.
No pneumoperitoneum.
A long segment of segmental large colonic wall thickening at the sigmoid colon with "water target appearance", measures approximately 20cm in length. It is associated with pericolic stranding and enhancement of the bowel wall.
A small outpouching at the distal sigmoid colon (S1 vertebral level) may represent phlegmon within the diverticulum.
No pneumoperitoneum.
No proximal bowel loops dilatation (both large and small bowel loops).
No abdominal and pelvic lymphadenopathy.
Peritoneal thickening noted at bilateral paracolic gutters.
Minimal ascites at the mesentery, pelvis and right paracolic gutter.
No other bowel wall thickening or bowel related mass.
The liver is normal in size. Multiple hypodense liver lesions of varying sizes are scattered throughout liver segments. The largest liver lesion at segment VII and another more minor lesion at segment VI have slightly higher attenuation than the other normal fluid attenuating liver lesions.
Cholelithiasis.
Case Discussion
It is in keeping with acute sigmoid diverticulitis (Hinchey classification stage Ia).
No CT evidence of perforation or abscess formation. The two ill-defined with slightly higher attenuating liver lesions may represent liver abscesses.
The patient was treated with antibiotics and recovered uneventfully. He was scheduled for an elective colonoscopy as an outpatient.
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