Presentation
Acute abdominal pain and guarding.
Patient Data
Diverticula throughout the colon. Focal fat stranding adjacent to a sigmoid diverticulum with a small amount of extraluminal fluid and gas locules. Significant amount of pneumoperitoneum. Appendix is normal in appearance. Previous cholecystectomy with associated intra- and extra-hepatic biliary duct dilatation. IUCD and IDC noted.
Long segment of sigmoid colon demonstrates numerous diverticula and extensive stranding in the surrounding fat. Some gas appears extra-luminal (arrow).
Vast quantities of free intra-abdominal gas are best seen in the upper abdomen (yellow arrows).
Case Discussion
This case demonstrates vast quantities of free intraperitoneal gas, arising from a focal region of diverticulitis on a background of more extensive colonic diverticulosis.