Perforated diverticulitis

Case contributed by Dr Rafael Lourenço do Carmo


Previously healthy patient, presenting with intense abdominal pain and hematochezia.

Patient Data

Age: Unknown
Gender: Male

CT shows multiple rectosigmoid diverticula, associated with wall thickening and stranding of adjacent fat. Free fluid is also seen in the abdominal cavity, as well as extraluminal gas foci (seen in the right upper quadrant, anteriorly to the transverse colon).

Non-related findings include lobar steatosis of the left hepatic lobe, mild aorto-iliac atherosclerosis and bilateral pleural effusions.


During laparotomy procedure, a perforated, inflamed diverticulum was found in the sigmoid colon. Sigmoidectomy was then performed. Photography shows surgical specimen, containing a brownish (inflamed) diverticulum. A perforation can be seen in its center.

Case Discussion

Colonic diverticular disease is very common entity to be found in elderly population. It affects 5% - 10% of the population over 45 years, and 80% of population over 80 years. Diverticula can be seen in all colonic segments, however they are much more often found in the sigmoid 1.

Acute diverticulitis is a colonic and pericolonic inflammatory condition, caused by obstruction of the diverticulum neck by stool, inflammation of food particles 1.

Most common CT findings are pericolic fat stranding, sometimes disproportionately prominent compared to the wall thickening, enhancement of the colonic wall.

Complications can also be seen in the CT, represented by extraluminal liquid or gas, suggesting perforation, abscess and/or fistula formation.

Treatment varies with presentation (for details check the article diverticulitis).

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