Ticking bomb in the abdomen

Dr/Ahmed Bahnassy

Consultant Radiologist

PSMMC

History

35 years old patient ,presented by abdominal pain ,and fever.

Leucocitic count was high.

MDCT was requested .

Sigmoid colon wal thickening

intense para colic inflammatory changes

fat stranding

fistula

abscess

gas filled out-

pouchings

gas filled out-

pouchings

abscess

fistula

Sigmoid colon wall thickening

para colic abscess

DD

• Diverticular disease .

• Crhon's disease.

• Perforated cancer colon.

• Ulcerative colitis .

top diagnosis

no skip lesions

young age

rectum is sparee

Final post operative diagnosis

Diverticular disease

Diverticular disease includes a spectrum of conditions ranging from asymptomatic diverticular disease, to symptomatic uncomplicated diverticular disease, and complicated diverticular disease that includes acute and chronic diverticulitis.

Diverticulitis

Diverticulitis is defined as an inflammation of one or more diverticula, which are small pouches created by herniation of mucosa into the wall of the colon. Diverticulitis is generally considered a disease of the elderly, but as many as 20% of patients with diverticulitis are younger than 50 years.

Fistulization

Fistula formation is a complication of diverticulitis. Fistulas to adjacent organs and the skin may develop, especially in the presence of an abscess.

In men, colovesicular fistulas are the most common.

In women, the uterus is interposed between the colon and the bladder, and this complication is only seen following a hysterectomy. The uterus precludes fistula formation from the sigmoid colon to the urinary bladder. However, colovaginal and colocutaneous fistulas can form but are uncommon.

Stages of diverticular disease

Stages of diverticular disease

SCAD(Segmental colitis associated with diverticulitis).

SCAD is a unique form of chronic colitis limited to areas of the colon with diverticular formation. Gore et al. first reported on the presence of an entity they termed “diverticular colitis”.

Often mistakenly diagnosed as either ulcerative colitis or Crohn’s disease, patients typically present with pain and intermittent rectal bleeding.

Note