Presentation
Abdominal pain.
Patient Data
Sigmoid diverticulosis without associated bowel wall thickening or pericolic fat stranding to indicate acute diverticulitis. No intra-abdominal free fluid or pneumoperitoneum. No dilated small or large bowel. Large hiatus hernia containing the entire stomach and tail of the pancreas as demonstrated previously. Large duodenal diverticulum.
The liver, spleen, adrenal glands, and kidneys are unremarkable noting a left parapelvic renal cyst. Normal opacification of the abdominal aorta and its branches noting scattered calcification including at the origin of the celiac trunk and superior mesenteric arteries which remain patent. No filling defect identified in the portal system.
Misty mesentery appearance of the central mesentery with associated small lymph nodes and ill-defined soft tissue densities in keeping with mesenteric panniculitis.
Disc-like vaginal pessary (gellhorn).
Impression
No acute intra-abdominal pathology identified. Sigmoid diverticulosis without associated features to suggest acute diverticulitis. No alternative cause for the patient's pain identified.
Case Discussion
Example of a silicon gellhorn pessary which has a characteristic flexible inferior stem.