Images in Clinical Medicine
Segmental Diverticulitis
N Engl J Med 2009; 361:286July 16, 2009
- Article
An 80-year-old man with a history of irritable bowel syndrome presented with a 5-day history of abdominal pain in the left lower quadrant, without aggravating or relieving factors. His last bowel movement had been 3 days before admission, without melena or hematochezia. He was afebrile and had normal vital signs. The abdomen was soft and was tender over the left lower quadrant, without guarding, rebound, rigidity, or palpable masses. Brown stool was negative for occult blood. The blood count, results of a comprehensive metabolic screening, and lipase and amylase levels were normal. Computed tomographic scanning of the abdomen and pelvis revealed diffuse colonic diverticulosis. In the sigmoid colon, there was a short, isolated segment of enhancement of the wall, with inflammatory changes and mesenteric stranding (Panel A, asterisks). (Also in Panel A, arrowheads indicate noninflamed diverticula, and P a penile prosthesis.) Colonoscopy of the cecum, performed to rule out ischemic colitis or tumor, revealed diffuse diverticulosis. An impacted fecalith (Panel B, arrows) with surrounding edema and erythema was seen in the sigmoid colon. Symptoms resolved after use of antibiotics for 7 days and have not recurred for more than a year since.
Robert S. Fisher, M.D.
Siva P. Doma, M.D.
Temple University Hospital, Philadelphia, PA 19140
siva.doma@tuhs. temple. edu
