Complicated diverticulitis

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:┬ádiverticulitis with pericolic or mesenteric abscess
  • stage II:┬ádiverticulitis with walled off pelvic abscess
  • stage III:┬ádiverticulitis with generalized purulent peritonitis
  • stage IV: diverticulitis with generalized fecal peritonitis
Author: radhianahassan