Diverticulitis and diverticular abscess of the sigmoid colon in a cirrhotic patient

Case contributed by Dr Mohammad A. ElBeialy

Presentation

45 years old male with hepatitis C is presenting with low grade fever, headache, malaise and diarrhea. Triphasic CT was requested to exclude hepatic focal lesion.

Patient Data

Age: 45 years
Gender: Male
  • Small diverticulosis of the recto-sigmoid associated with mild wall thickening and peri-colic fat stranding as well as small peri-colic lymphadenopathy.
  • A heterogeneously enhancing mass lesion with predominantly marginal enhancement and central necrotic portion is seen related to the proximal sigmoid colon with associated inflammatory changes of the distal ileum. The lesion measures about 10 X 8 X 9 cm in its maximal TS, AP and CC dimensions, respectively. Associated peri-lesional fat stranding as well as small lymphadenopathy is noted. No evidence of pneumoperitoneum.
  • The liver is not enlarged and shows cirrhotic configuration with heterogenously hypodense parenchyma and irregular outline with rather hypertrophied left and caudate lobes as well as prominent inter-lobar fissure. No definite focal hepatic lesion or intra-hepatic biliary radicles dilatation.
  • The spleen is mildly enlarged with no definite focal lesion.
  • Normal panaceas.
  • Horseshoe kidneys with fusion of their lower poles across the midline and associated malrotation of both kidneys. No renal masses, stones or hydronephrotic changes.
  • Small shotty para-aortic and porta-hepatis lymphadenopathy are seen.
  • No ascites.
  • The scanned lung bases show bilateral basal sub-segmental consolidations with air bronchogram as well as small basal atelectasis.

Case Discussion

  • Diverticular disease of the recto-sigmoid with diverticulitis and diverticular abscess. No evidence of pneumoperitoneum.
  • Liver cirrhosis, no focal hepatic lesion.
  • Horseshoe and malrotated kidneys.
  • Small portahepatis and para-aortic lymphadenopathy.
  • Bilateral basal sub-segmental pneumonic consolidations.

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Case Information

rID: 29581
Case created: 6th Jun 2014
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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