Clinical History
Pain and tenderness localized at the left lower abdominal quadrant .
Imaging Findings
A 77 year old male with sigmoid diverticulosis presented with abdominal pain, low fever and tenderness in the left lower quadrant. A significative leucocytosis was not present.
Double Contrast Barium Enema was not completated because of abdominal pain prevented air insufflation.
Abdominal CT scans were performed and revealed a fluid collection surrounding the sigmoid colon.
Discussion
Colonic diverticula are saccules made of colonic mucosa. The mucosal layer herniates from the colonic lumen through the muscolar layer of the colonic wall where straight vessels penetrate, to form these saccules.
Inspissated faeces caught in the diverticula erodes the mucosa and causes local infection, abscesses and perforation.
CT is a useful technique in this condition, because it can demonstrate intra or extramural inflammation.
CT images infact can show the wall tickening, the increased density of the pericolic fat, tickening of root of mesentery, intramural and pericolic abscess formation, fistula formation, and abdominal soft tissue masses that can be associated to diverticulitis.
Because of its non invasive nature, CT can play an important role in the acute phase of diverticulitis when there may be reluctance to perform a Double Contrast Barium Enema. Double contrast barium enema is actually considered the modality of choice for detecting diverticula in elective conditions, altough it is very important in case of diverticulitis because of it can confirm the presence of diverticula and also show inflammatory strictures or fistulas frequently associated to this condition.
Differential Diagnosis List
Diverticulitis complicated by pericolic collection of inflammatory fluids.
Final Diagnosis
Diverticulitis complicated by pericolic collection of inflammatory fluids.
