Presentation
Severe abdominal pains on the left iliac region.
Patient Data
There is localised echogenic and non compressible mesenteric fat noted around the aperistaltic sigmoid colon. Focal bowel wall thickening (5.5 mm) is also demonstrated in this tender region. No surrounding mass or fluid collection. No mesenteric or para aortic adenopathy demonstrated.
The liver is of mildly enlarged. No focal hepatic lesion is seen. There is moderate diffuse hepatic echo attenuation obscuring the periportal and sub diaphragmatic echoes.
The liver is normal in size and diffusely hypodense with no focal liver lesion. Sigmoid colonic diverticulosis is seen with extensive surrounding fat stranding. No free intraperitoneal air noted. The appendix is normal. Bridging osteophytes are seen in the sacroiliac joints associated periarticular sclerosis.
The rest of the organs are unremarkable.
Case Discussion
These features are in keeping with sigmoid colonic diverticulitis with no evidence of perforation. On imaging, colonic diverticulitis is characterised by segmental colon wall thickening with surrounding fat stranding and adjacent diverticula. Sigmoid colon is the most common affected site.
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