EURORAD ESR

Case 10919

Colouterine fistulisation from sigmoid colon diverticulitis

Author(s)
Tonolini Massimo, Villa Chiara

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 88 year(s)
 
 
  • Figure 1
    Initial, urgent-setting unenhanced CT
     

    Unenhanced acquisition due to renal impairment discloses previously unknown, large unruptured aneurysm of the infrarenal abdominal aorta with extensive mural calcifications.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    In the pelvis, the sigmoid colon shows extensive diverticular changes with mural thickening, and faecal-filled outpouching (arrowhead) interpreted as suspicious for contained perforation.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Furthermore, gas bubbles and faeces-like material (arrow) are seen in the uterus, which is enlarged for the patient's age. Free intraperitoneal air, haemorrhage, or effusion are excluded.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;
     
     
  • Figure 2
    Repeat contrast-enhanced multidetector CT including multiplanar reformations
     

    With improved renal function, repeat MDCT with intravenous contrast confirms unruptured infrarenal aortic aneurysm with extensive intraluminal thrombosis.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Acute diverticulitis of the sigmoid colon is confirmed, with diffuse mural thickening and mild fascial fluid.

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body, closely adherent to the thickened sigmoid colon.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body, which compresses the uterine cavity (arrowhead).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Additionally, a fluid-filled fistulous track (thin arrows) is detected, connecting the thickened sigmoid colon to the myometrial collection (arrows) in the closely adherent uterine body.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;

    Additionally, a fluid-filled fistulous track (thin arrows) is detected, connecting the thickened sigmoid colon to the myometrial collection (arrows) in the closely adherent uterine body. Note compressed uterine cavity...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Diverticula;
     
     
Unenhanced acquisition due to renal impairment discloses previously unknown, large unruptured aneurysm of the infrarenal abdominal aorta with extensive mural calcifications.
 
In the pelvis, the sigmoid colon shows extensive diverticular changes with mural thickening, and faecal-filled outpouching (arrowhead) interpreted as suspicious for contained perforation.
 
Furthermore, gas bubbles and faeces-like material (arrow) are seen in the uterus, which is enlarged for the patient's age. Free intraperitoneal air, haemorrhage, or effusion are excluded.
 
With improved renal function, repeat MDCT with intravenous contrast confirms unruptured infrarenal aortic aneurysm with extensive intraluminal thrombosis.
 
Acute diverticulitis of the sigmoid colon is confirmed, with diffuse mural thickening and mild fascial fluid.
 
Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body.
 
Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body, closely adherent to the thickened sigmoid colon.
 
Multiplanar reformatted images confirm mixed air- and fluid-filled collection (arrows) in the dorsal portion of the uterine body, which compresses the uterine cavity (arrowhead).
 
Additionally, a fluid-filled fistulous track (thin arrows) is detected, connecting the thickened sigmoid colon to the myometrial collection (arrows) in the closely adherent uterine body.
 
Additionally, a fluid-filled fistulous track (thin arrows) is detected, connecting the thickened sigmoid colon to the myometrial collection (arrows) in the closely adherent uterine body. Note compressed uterine cavity (arrowhead).
 
 
 
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