Presentation
A few days of left lower quadrant pain and fever. New erythema around the umbilicus and sudden onset discharge through umbilicus.
Patient Data
Focal inflammation of a diverticulum arising from the posterior wall of the sigmoid with surrounding fat stranding and adjacent peritoneal thickening. Separately, a large abscess with gas and fluid in the abdominal wall at the umbilicus and immediately deep to it. Sigmoid colon is in contact with the deep aspect of the abscess. No generalized pneumoperitoneum.
Case Discussion
There is one clear site of focal acute diverticulitis, with a separate large abscess draining externally through the umbilicus, and this was considered to also be a complication of diverticulitis. Percutaneous drainage was not required due to the free passage of pus through the umbilicus. As well as abscess drainage through the skin, diverticular disease may be complicated by direct enterocutaneous fistulation.