Radiology Teaching Files > Case 1530817

Contributed by: Residents and Faculty Baptist Health System Birmingham Alabama, Radiologist, Baptist Health System Hospitals Birmingham, Alabama, USA.
Patient: 79 year old female
This case has no images yet.

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


Incidence: 10-25% of diverticular disease

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

Location: Sigmoid colon (most common)

- 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

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

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

No comments posted.
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

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please send email to