Acute diverticulitis

Case contribution: Dr Radhiana Hassan


  • A 58 years old man
  • No known medical illness
  • Presented with left sided abdominal pain for 2 days
  • Associated with PR bleed and fever
  • FBC showed elevated white blood cells

Radiographic findings:

  • Abdominal radiograph shows a focal bowel loops at left lumbar region (red arrows) with thickened mucosa.
  • No abnormal dilatation of bowel loops seen.
  • No free air.

Ultrasound findings:

  • A focal bowel loop with thickened and oedematous wall is seen at left lower abdomen region. Absence of peristalsis of this bowel loop.
  • No bowel dilatation seen. No free fluid.
  • No other abnormality seen.

CT Scan findings:

  • There is a long-segment wall thickening involving the distal transverse colon to sigmoid colon (red arrows).
  • This thickened wall showed abnormal mucosal enhancement.
  • The thickening causes significant narrowing of the lumen, however no dilatation of bowel loops proximal to this.
  • Multiple diverticulosis (white arrows) are seen at sigmoid and distal descending colon.
  • There is no obvious contrast extravasation or extraluminal air to suggest perforation.
  • There is no focal collection to suggest abscess formation.
  • There is mesenteric streakiness adjacent to the thickened bowel loops.
  • A few shotty mesenteric and paraortic nodes are seen.

Diagnosis: Acute colonic diverticulitis.


  • Colonic diverticulitis is an inflammation and a complication of the colonic diverticulosis (outpouchings of the bowel wall).
  • Imaging findings of uncomplicated diverticulitis include edematous thickening of the bowel wall, pericolic mesenteric fat stranding and enhancement of colonic wall.
  • Complications include perforation, phlegmon, abscess, ascending septic thrombophlebitis (phylephlebitis), bleeding, intestinal obstruction, and fistula.
  • Uncomplicated diverticulitis can be treated conservatively; however, complicated diverticulitis may not be responsive to medical treatment and life-threatening conditions may occur.
  • Differential diagnosis include colorectal carcinoma, ischaemic colitis and inflammatory bowel disease

Progress of patient:

  • Patient was discharged well after conservative treatment
Author: radhianahassan