Presentation
Right-sided abdominal pain. Tender right side of abdomen. Raised inflammatory markers. No gallstones or cholecystitis found on ultrasound.
Patient Data
Inflammation of the distal half of the ascending colon on a background of pancolonic diverticulosis. There is mural thickening, pericolic fast stranding, and thickening of the adjacent retroperitoneal fascial planes. A diverticulum lies at the epicenter of the inflammation. There is no fluid collection and no free air. The findings are consistent with ascending colon diverticulitis.
Bilateral lower pole renal stones are noted. Diffuse hepatic steatosis.
With conservative treatment for ascending colon diverticulitis, there was an uneventful recovery.
CT KUB due to new left-sided colicky pain.
The left lower pole stone has fragmented and a large portion has passed into the proximal left ureter and causes upstream dilatation. A small stone is present in an interpolar region calyx. The right renal lower pole stone is unchanged in appearance.
The previously seen ascending colon inflammatory changes have all resolved.
Case Discussion
The finding of segmental colitis on a background of diverticulosis, with a distended diverticulum at the epicenter of the inflammation, is highly suggestive of acute diverticulitis. In most Western populations, diverticulitis is seen more commonly affecting the sigmoid colon, but a propensity to right-sided diverticulitis has been reported in Asian populations.