Perforated sigmoid diverticulitis with peritonitis
Left lower quadrant pain.
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Perforation of a sigmoid diverticulum with collection of extraluminal stool along the rightward aspect of the sigmoid colon.
Few small scattered foci of free air. Ascites with few collections of mottled air suggesting stool spillage. Thickening and hyperenhancement of several loops of small bowel.
Perforation of a sigmoid diverticulum with collection of extraluminal stool at the site of perforation. Small amount of stool mixed with ascites in the pelvis. Small bowel is thickened with mucosal and serosal hyperenhancement sandwiching submucosal edema, with some loops showing more diffuse hyperenhancement. This is due to peritonitis from perforation.
The key to identifying the perforation in this case is noticing where the majority of the free air and extraluminal stool is - in the pelvis, and about the sigmoid colon.