Complicated diverticulitis (pericolic abscess)
Updates to Case Attributes
This case shows colonic diverticulitis in a young adult that has complicated with the formation of a pericolic abscess anterior to the sigmoid colon. The collection has drained purulent material. It likely represents a complication related to a contained perforation.
- +<p>This case shows <a title="Colonic diverticulitis" href="/articles/diverticulitis">colonic diverticulitis</a> in a young adult that has complicated with the formation of a pericolic <a title="Abscess" href="/articles/abscess">abscess</a> anterior to the <a title="Sigmoid colon" href="/articles/sigmoid-colon">sigmoid colon</a>. The collection has drained purulent material. It likely represents a complication related to a contained perforation. </p>
Updates to Study Attributes
Surrounding a short segment of the sigmoid colon there is fat stranding and a small amount of free fluid. The presence of a few colonic diverticula, with a larger one involved by the inflammatory process, makes colonic diverticulitis the most likely diagnosis.
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Updates to Study Attributes
A pericolonicpericolic collection containing fluid and gas lies anterior to the sigmoid colon.
The collection measures 6.3 cm transversely X 5.1 cm AP X 4.5 cm craniocaudally. There There is marked adjacent fat stranding within the sigmoid mesocolon.A number of diverticula are noted within the descending colon.No free intra peritoneal air.The liver, spleen, pancreas, adrenal glands and kidneys are unremarkable.No enlarged lymph nodes evident. No free fluid
Conclusion:
Pericolonic abscess anterior to the sigmoid colon, likely secondary to complicated diverticular disease ( contained perforation).
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Image CT (C+ portal venous phase) ( update )
Updates to Study Attributes
The procedure, with its potential risks and complications, was discussed with the patient, including the option of not performing the procedure. Verbal and written consent was obtained. We are thankful to the referring team for organising the written consent.Time-out: A time-out was observed to confirm the correct patient, procedure, and site.Findings: The collection with gas and fluid content was identified and its relation with the sigmoid colon reviewed under ultrasound. BestThe best safe approach was planned.Procedure: With the patient in supine position, the skin was prepped and draped in usual sterile fashion. Local anesthesiaanaesthesia was performed using 1% ligdocainelidocaine. Under ultrasound guidance, the 12 Fr multipurpose drainage catheter was inserted into the collection. Brownish thick fluid drained spontaneously. Sample obtained and given to the EGS registrar.
Updates to Freetext Attributes
The patient hasn't improved with the conservative management and represents in ED almost a week later.
Updates to Freetext Attributes
Complications related with colonic diverticulitis are:
- abscess formation
-
fistula formation
- bladder: colovesical fistula
- vagina: colovaginal fistula
- bowel: coloenteric fistula or colocolic fistula
- skin: colocutaneous fistula
- small bowel obstructions from adhesions
- perforation resulting in pneumoperitoneum
In this case, radiology has been asked to insert a percutaneous catheter for the abscess drainage.