A 47-year- old male patient was admitted to  hospital reporting acute onset of severe left iliac fossa pain. Past medical history was unremarkable. Physical examination revealed abdominal tenderness and a slight elevation of body temperature. An abdominal ultrasound was requested.Sonographic examination of left iliac fossa demonstrated hypoechoic wall thickening of a colonic segment surrounded by ill defined hyperechoic pericolic fat changes and thickened gut wall with a target pattern.


Further evaluation of the findings was decided and a CT was performed.
What is the most likely diagnosis?

ANSWER

Most likely diagnosis is Sigmoid diverticulitis

CT findings are Sigmoid wall thickening, presence of a diverticulum and fluid collection in left paracolic sulci.

Diverticula are sac-like protrusions of mucosa through the colonic wall, along the natural openings created by intramural nutrient vessels. Due to higher intraluminal pressure, they are more frequently observed at the level of sigmoid colon.

CT with oral and intravenous contrast is considered the imaging modality of choice for assessing the disease and may reveal segmental thickening of the bowel, enhancement of the colonic wall, pericolic fat stranding, extravasation of air and fluid into the pelvis and peritoneal cavity, abscesses and signs associated to fistula formation.

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