Perforated sigmoid diverticulitis with peritonitis

Case contributed by Dr Michael P Hartung

Presentation

Left lower quadrant pain.

Patient Data

Age: 75 years
Gender: Female

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. 

Case Discussion

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. 

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Case information

rID: 67069
Published: 18th Mar 2019
Last edited: 20th Mar 2019
Inclusion in quiz mode: Included

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