Perforated small bowel diverticulitis

Case contributed by Dr T Fassaert


Acute onset of pain in left abdomen with guarding and moderately elevated leucocyte count. Because lack of cause and persistent complaints, an abdominal CT was ordered.

Patient Data

Age: 64
Gender: Male

Axial slices through the upper abdomen. There are outpouchings (diverticula) on the mesenteric side of duodenum and jejunum, filled with contrast and/or air. These are better appreciated when viewing them on successive slices. On the left side some fat stranding and focal free air is visible, caused by a  perforation of one of the diverticula (so-called "sealed" perforation).

Annotated image

Selected slice highlighting:

  • diverticulum = blue arrow
  • free gas = yellow arrow
  • fat stranding = red arrow

Case Discussion

A healthy male presents at the emergency department with acute abdominal pain and guarding in the left hemiabdomen. He had no fever and no other symptoms. On physical examination, there was tenderness and local guarding.

Lab results showed no abnormalities other than mildly elevated leucocyte count  and C-reactive protein. Standing chest x-ray showed no free air.

Case supervised and validated by Dr Erik Ranschaert

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Case information

rID: 13873
Published: 26th May 2011
Last edited: 14th Sep 2015
Inclusion in quiz mode: Included

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