Diverticulitis

Rakesh Nanda, M.D., and Jafar Amini, M.D.

N Engl J Med 1995; 333:498August 24, 1995

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Figure 1 A 70-year-old, previously healthy man had had sudden, colicky lower abdominal pain and increased urinary frequency for four days. He had marked suprapubic tenderness but no other abnormal physical findings. There was mild leukocytosis and a slight leftward shift; the results of urinalysis were unremarkable. A computed tomographic (CT) scan of the pelvis obtained on the first hospital day (Panel A and adjacent sketch) shows thickening of the sigmoid colon (thick arrows). The dark areas represent gas in the lumen, and the white areas represent contrast material. The small dark areas (thin arrows) represent gas in diverticula. A low-pressure barium enema (Panel B) performed on the same day revealed moderate narrowing of the distal sigmoid colon due to mucosal thickening and spasm (curved arrows), corresponding to the CT findings, and multiple diverticula in the proximal sigmoid colon (arrows). Within 48 hours of the initiation of therapy with metronidazole and clindamycin, the patient's pain, tenderness, and urinary frequency decreased. Three weeks later, when he was symptom-free, flexible sigmoidoscopy, carried out because of his concern about cancer, revealed wide-mouth diverticula with normal mucosa (Panel C). The patient remained well during 15 months of follow-up.

Kim Eagle, M.D.

Rakesh Nanda, M.D.
Jafar Amini, M.D.
Dwight D. Eisenhower Medical Center, Leavenworth, KS 66048

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