Clinical:
- A 63 years old man
- History of stab injury at left flank in 1991, managed with simple T&S
- Presented with altered bowel habit for one month
- Constipation with mucoid discharge
- No blood in stool, no diarrhoea, no tenesmus
- Associated loss of appetite and loss of weight
- BP=117/75 mmHg, PR=97 bpm
- Per abdomen soft not distended
- Mass at left flank over scar site 8×8 cm, not reducible, underlying scar defect
- PR empty rectum no mass palpable
- Investigation: elevated WBC
- Abdominal radiograph and ultrasound abdomen are unremarkable
CT scan findings:
- thickening of the sigmoid wall
- Presence of diverticulosis
- pericolic fat stranding
- Abscess formation anterior to rectum
- no fistula seen
- lateral ventral hernia at previous injury site
Diagnosis: Acute diverticulitis complicated with abscess formation
Hinchey classification of acute diverticulitis:
- stage Ia: phlegmon
- stage Ib: diverticulitis with pericolic or mesenteric abscess
- stage II: diverticulitis with walled off pelvic abscess
- stage III: diverticulitis with generalized purulent peritonitis
- stage IV: diverticulitis with generalized fecal peritonitis
