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Colonic diverticulitis progress to diverticular abscess

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Abdominal pain

Patient Data

Age: 50 years
Gender: Male

Colonic diverticulosis involving the descending and sigmoid colon with related stranding of sigmoid mesentery.

Delayed scan after 12 hours

ct

Delayed scan after 12 hours (colonography) shows the contrast inside the large bowel filling colonic diverticula and diffuse thickening of colonic mucosa of the descending and sigmoid colon.

Foci of air are seen on sigmoid mesentery suggestive of diverticular perforation. Foci of air are seen related to left hepatic lobe indicating minimal pneumoperitoneum.

Follow up after 6 days

ct

Multiple encysted fluid collections are seen, some of them show air-fluid levels, largest measures 4.2 x 4.9 cm in axial dimensions with marked surrounding mesenteric fat stranding, one of them are retroperitoneal at left iliac fossa peritoneal reflection. Features are in keeping with multiple pericolic abscesses.

Incidental retro-aortic left renal vein.

Case Discussion

Colonic diverticulitis is an important cause of abdominal pain in older adults, in which third of the patients develop a diverticular abscess. This is considered stage II according to Hinchey classification for acute diverticulitis which may be drained by interventional radiology.

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