Diverticulitis, renal obstruction and fistula

Case contributed by Dr Jeremy Jones

Presentation

Outpatient. Generally feeling unwell with long standing left iliac fossa pain. Left sided tenderness, but no guarding. Colonscopy is normal.

Patient Data

Age: 55
Gender: Female
Modality: CT

A moderately long segment of abnormal sigmoid colon with numerous diverticula and significant surrounding inflammatory change.  Numerous locules of gas that sit outwith the colon are suspicious for fistula.

Compression of the distal left ureter with hydroureter and hydronephrosis and differential enhancement of the renal parenchyma suggesting impending failure of the kidney.

The uterus is directly oposed to the mass and there is concern for a uterocolic fistula although there is no gas within the uterus or tubes.  Bladder wall thickening, but no intra-vesicular gas.

Note is also made of a hiatus hernia.

Case Discussion

This patient was scanned as an outpatient.  The concern for impending failure of the left kidney and possibility of further complications related to diverticular disease promped the referring clinician (a gastroenterologist) to arrange admission as well as urological and surgical reviews.

The kidney was decompressed and a defunctining stoma considered.  No evidence of uterocolic fistula was demonstrated.

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Case Information

rID: 14303
Case created: 14th Jul 2011
Last edited: 23rd Dec 2015
Inclusion in quiz mode: Included

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