Figure 1
Barium enema study
There are a lot of colonic diverticula, mainly in the sigma, associated to a contracted aspect of sigmoid wall.
Sigmoid Diverticulitis
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsGraziella Donatelli, Eugenia Picano, Alessia Ceccarelli, Davide Caramella
Connected authors
65 years, female
Clinical History
A female patient presented with a three-months leukocytosis, constipation, diffuse abdominal tenderness and pain for three months.
Imaging Findings
The patient presented with a three-months leukocytosis, abdominal tenderness, pain and constipation. She has not family record of colonic cancer; markers and hidden blood were negative.
We performed a colonoscopy, which was not diagnostic (interrupted because of intolerance of the patient); a CT colonography which was not diagnostic because of pain during insufflation; a barium enema examination (Fig 1), which showed colonic diverticula, principally in the sigma, associated to a contracted aspect of the sigmoid wall; a CT with i.v. contrast administration (Fig 2), which confirms the existence of sigmoid diverticula and shows sigmoid wall thickening, caused by inflammation.
CT was performed because of pain persistence although the patient was under medical therapy for diverticulitis.
We performed a colonoscopy, which was not diagnostic (interrupted because of intolerance of the patient); a CT colonography which was not diagnostic because of pain during insufflation; a barium enema examination (Fig 1), which showed colonic diverticula, principally in the sigma, associated to a contracted aspect of the sigmoid wall; a CT with i.v. contrast administration (Fig 2), which confirms the existence of sigmoid diverticula and shows sigmoid wall thickening, caused by inflammation.
CT was performed because of pain persistence although the patient was under medical therapy for diverticulitis.
Discussion
Sigmoid diverticula are outpouchings of the sigmoid wall. They can appear everywhere in the colon but they are most frequent in the sigma. The term for inflammation of diverticula wall is diverticulitis. Acute diverticulitis is usually characterized by fever, leukocytosis, abdominal pain, tenderness and constipation. If inflammation persists for some weeks, fever can disappear.
Barium enema study is not able to demonstrate pericolic abscess and other extraluminal changes.
Main CT features of diverticulitis are: localized thickening of the bowel wall (usually the length of bowel involvement is more than 5 cm); pericolonic edema; peridiverticular abscess.
CT may not be diagnostic in the early stage of diverticulitis, when there is not a significant pericolic inflammation. It allows to monitor complications of diverticulitis.
Differential diagnosis of diverticulitis have to be made with other colonic inflammation, other causes of abdominal pain and colon cancer, which have similar symptoms, colonic wall thickness, main localization and age of patients. Cancer markers, imaging, presence of diverticula and response to medical therapy are fundamental for a correct diagnosis. Sometimes, if there is not response to medical therapy, histological evaluation can be fundamental.
Usually medical therapy is sufficient to resolve inflammation. If complications appear, i.e. perforation, colonic obstruction, abscess or bleeding, surgery can be the optimal approach.
Barium enema study is not able to demonstrate pericolic abscess and other extraluminal changes.
Main CT features of diverticulitis are: localized thickening of the bowel wall (usually the length of bowel involvement is more than 5 cm); pericolonic edema; peridiverticular abscess.
CT may not be diagnostic in the early stage of diverticulitis, when there is not a significant pericolic inflammation. It allows to monitor complications of diverticulitis.
Differential diagnosis of diverticulitis have to be made with other colonic inflammation, other causes of abdominal pain and colon cancer, which have similar symptoms, colonic wall thickness, main localization and age of patients. Cancer markers, imaging, presence of diverticula and response to medical therapy are fundamental for a correct diagnosis. Sometimes, if there is not response to medical therapy, histological evaluation can be fundamental.
Usually medical therapy is sufficient to resolve inflammation. If complications appear, i.e. perforation, colonic obstruction, abscess or bleeding, surgery can be the optimal approach.
Differential Diagnosis List
Sigmoid diverticulitis.
Final Diagnosis
Sigmoid diverticulitis.
References
[1] Cho KC, Morehouse HT, Alterman DD, Thornhill BA (1990) Sigmoid diverticulitis: diagnostic role of CT-comparison with barium enema studies. Radiology 176:111-115. (PMID: 2191360)
[2] Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD (1999) Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 210:429-435. (PMID: 10207426)
[3] Goh V, Halligan S, Taylor SA, Burling D, Bassett P. Bartram CI (2007) Differentiation between diverticulitis and colorectal cancer. Radiology 242:456-462. (PMID: 17255417)
Case information
| URL: | https://www.eurorad.org/case/7357 |
| DOI: | 10.1594/EURORAD/CASE.7357 |
| ISSN: | 1563-4086 |
Figure 2
CT study
Venous phase of CT study. It shows sigmoid diverticula and sigmoid wall thickening, caused by inflammation.
Barium enema study
There are a lot of colonic diverticula, mainly in the sigma, associated to a contracted aspect of sigmoid wall.
CT study
Venous phase of CT study. It shows sigmoid diverticula and sigmoid wall thickening, caused by inflammation.