Diverticulitis with abscess

Case contributed by Sajoscha A. Sorrentino


Lower abdominal pain increasing over past few days.

Patient Data

Age: 75 years
Gender: Male

A 4 cm diameter rounded collection of fluid superiorly adjacent to the sigmoid colon which contains many diverticulae and is thick walled. It is in close proximity to the bladder wall, which also appears thickened. No gas can be seen in the bladder lumen to suggest a colovesical fistula.

In addition the aorta is aneurysmal with extensive irregular mural thrombus and extensive vascular calcification seen along the entire arterial tree. The right common femoral artery is also aneurysmal with evidence of previous intervention in the region. 

Incidental renal cysts and splenunculus noted. Extensive calcified pleural plaques are also noted, presumably representing prior asbestos exposure. 

Annotated image

See individual findings below:

- long segment of thickened sigmoid colon with numerous diverticula and extensive stranding of the adjacent fat and thickening of the nearby bladder wall (*)

- mostly air-filled extraluminal collection (blue dotted line) with an air-fluid level is consistent with an abscess

- incidental splenunculus (yellow), with irregular mural thrombus in the aorta

- aneurysmal AAA (red) with mural thrombus

- bilateral extensive calcified pleural plaques (green) indicative to likely prior asbestos exposure

- renal cysts (orange) are a common incidental finding but should be examined for atypical features. The larger medial cyst appears to have a thin septation

Case Discussion

This case demonstrates extensive changes of acute diverticulitis with air containing abscess formation. 

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