Presentation
Left-sided abdominal pain. Microscopic hematuria.
Patient Data
No renal, ureteric or bladders stones, and no hydronephrosis or fat stranding. Sigmoid colon thickening and adjacent fat stranding and edema. Appearances indicate sigmoid diverticulitis rather than renal colic as the cause of symptoms, and a contrast-enhanced CT is advised.
A contrast-enhanced CT confirms the initial diagnosis of acute sigmoid diverticulitis with localized inflammatory change involving the colon and pericolic fat. The fat stranding extends up the left retroperitoneum, but there is no filling defect within the left ovarian vein or the inferior mesenteric vein. The peri-ureteric inflammation may account for the microscopic hematuria. There is a small volume of free fluid in the pelvis but no abscess and no perforation, and there is no fistula.
Case Discussion
This case highlights the importance of scrutinising all of the structures outside of the renal tract on CT studies acquires primarily to detect renal tract stone disease ("CT KUB"). The cause of the presentation was actually acute uncomplicated sigmoid diverticulitis, although the microscopic hematuria may be explained by the retroperitoneal inflammation involving the left ureter.