Perforated diverticulitis with pneumoperitoneum

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Generalized abdominal pain with nausea and decreased appetite.

Patient Data

Age: 50 years
Gender: Male

Pneumoperitoneum with air under the diaphragm in the supine frontal scout as well as abutting the anterior abdominal wall in the lateral scout. 

  • The sigmoid colon shows relatively long segment of about 12.5 cm with significantly diffuse mucosal thickening seen evidently encroaching upon the lumen with diverticular outpouchings as well as significant peri-sigmoidal fat infiltration with small pockets of fluid collection and free intra-peritoneal air is noted within the pelvic and abdominal peritoneal cavity seen abutting the anterior abdominal wall and infradiaphragmatic.  Linear gas densities are noted as well as at the hepatic hilum along the main portal vein as well as the proximal main right and left portal vein branches.  
  • The liver is mildly enlarged in size with diffuse alteration of its parenchyma denoting hepatic fatty infiltration.  No definite focal hepatic lesions. No CT evidence of intra or extra hepatic biliary radicle dilatation. Patent average caliber of the portal vein, no porta hepatis lymph nodes seen. 
  • Calcular gall bladder with small gall stones. No masses or definite CT evidence of cholecystitis.
  • Average size of the spleen. No splenic focal lesion. Average size with normal shape of both kidneys. No renal masses, stones or hydronephrotic changes.  Normal CT appearance of pancreas, aorta and IVC. No paraaortic or retro crural lymphadenopathy. No ascites.
  • Mild prostatomegaly is noted with homogeneous parenchyma as well as small foci of prostatic concretions.  No definite focal prostatic lesions.  Intact prostatic capsule. 
  • Regular filling of the urinary bladder. No masses or significant wall thickening seen. No enlarged pelvic lymphadenopathy.
  • The scanned lung bases shows traces of minimal bilateral pleural effusion as well as basal atelectatic bands. 

Case Discussion

Perforated sigmoid diverticulitis with significant perisigmoidal fat infiltration as well as small pockets of fluid collection and pneumoperitoneum.

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Case information

rID: 49553
Case created: 26th Nov 2016
Last edited: 5th Jul 2017
Inclusion in quiz mode: Included

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