MyPACS.net: Radiology Teaching Files > Case 1530817

never visited COLONIC DIVERTICULITIS WITH SMALL PERICOLONIC ABSCESS
Contributed by: Residents and Faculty Baptist Health System Birmingham Alabama, Radiologist, Baptist Health System Hospitals Birmingham, Alabama, USA.
Patient: 79 year old female
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Findings:

Barium enema demonstrating narrowing of the sigmoid colon with multiple diverticula in sigmoid and distal descending portion. Appears to be a mass just medial to sigmoid colon causing slight extrinsic compression.
CT of the pelvis demonstrating large pericolonic abscess within the sigmoid region causing extrinsic compression upon the sigmoid colon.

Diagnosis: colonic diverticulitis with small pericolonic abscess
Discussion:

COLONIC DIVERTICULITIS

Incidence: 10-25% of diverticular disease

Pathogenesis: mucosal abrasion from inspissated fecal material leads to perforation of thin wall.

Location: Sigmoid colon (most common)

Clinical:
- localized ileus / bowel obstruction
- gas in abscess / fistula
- focal area of eccentric luminal narrowing caused by pericolic / intramural inflammatory mass
- marked thickening / distortion of mucosal folds

Radiographic Findings:
- extraluminal contrast = peridiverticulitis
- "double tracking" = pericolonic longitudinal sinus tract
- pericolonic collection = peridiverticular abscess
- fistula to bladder / small bowel / vagina
- CT findings
a) Fine linear strands within pericolic fat (98%)
b) diverticula (84%)
c) circumferential bowel wall thickening of 4-12 mm (70%)
d) Frank abscess (47%)
e) Fistula formation (14%): most commonly colovesical

Prognosis:
a) Self-limiting
b) transmural perforation
c) superficial ulceration
d) chronic abscess

Rx: Antibiotics, surgery (25%), percutaneous abscess drainage

Comments:
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Additional Details:

Case Number: 1530817Last Updated: 04-29-2005
Anatomy: Gastrointestinal (GI)   Pathology: Infection
Exam Date: 05-18-1990Access Level: Readable by all users
Keywords: narrowing of colonACR: 750.273

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