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Diverticulitis

Posted Sun, 06/01/2008 - 06:17 by Vikram Dogra

Images

Figure 1

Figure 2

Clinical History:

A 51 year old female evaluated in the emergency department for right lower quadrant pain and fever concerning for appendicitis.

Findings:

Figure 1: Axial CT image showing sigmoid colon wall thickening greater than 3 mm and inflammatory change. Multiple diverticula are visualized within this segment of bowl.

Figure 2: Axial CT image showing a prominent enhancing diverticula.

Diagnosis:

Sigmoid diverticulitis.

Discussion:

Diverticulitis is a common complication of diverticulosis and represents local infection of diverticular disease. Diverticula are local outpouchings of the colonic wall that occur at points of vasa recta penetration into the muscularis propria. Sigmoid colon is the most common site of involvement with approximately 65% of cases demonstrating disease in the sigmoid colon. Diverticulitis complicates between 15-20% of patients with diverticulosis and is typically manifested as abdominal pain, fever and malaise. A CBC with differential typically shows leukocytosis with a left shift.

CT is the diagnostic test of choice for diverticulitis because it can image transmural & extraluminal disease as well as assess complications of disease with a sensitivity of between 85-97%. Colonic diverticula, colonic wall thickening greater than 3mm, and pericolic fat inflammation are common manifestations of disease visualized on CT.

References / Suggested Reading: