A 29 y.o. male comes in with L flank pain
What does the CT show?
CT was correctly read by the junior in EM1. Great work Scott!
Our patient had diverticulitis. Diverticular disease is one of the most prevalent conditions in western society. While it primarily affects the elderly with 50% of individuals over 60 being affected, there is an increasing incidence in individuals under 40. 10-25% of individuals over 60 with diverticular disease will develop diverticulitis. It is a disease of western society with Europe, Australia and the US having the highest prevalence. In Africa and Asia the prevalence is less than 0.5% presumably because of the increased fiber in the diet and therefore shorter transit times and less intraluminal pressure.
our patient with a L sided diverticulum
It is important to recognize diverticular disease because of its complications: pain, peridiverticular abscess, bleeding, perforation, fistulae, strictures and obstruction. A clinical entity of segmental colitis associated with diverticula (SCAD) has been more recently recognized where there is friable mucosa in the region of diverticula. Case reports have suggested that these patients should be treated with aminosalicylates because some progress to inflammatory bowel disease.
diverticulae on colonoscopy
For diverticulitis without significant complications which includes about 75% of cases, the mainstay of treatment includes bowel rest or clear fluids, antibiotics and pain control. Gram negative and anaerobic coverage is given with Cipro and Flagyl. Four to six weeks after resolution of the first attack of diverticulitis patients should undergo colonoscopy to rule out cancer. One third of patients will have a second attack.
The decision to admit is based on clinical status at presentation. Patients who are immunosuppressed, are toxic looking with high fever, have no home support, and are unable to tolerate po fluids should be admitted. Our patient was discharged on Cipro and flagyl and did well.
an 86 y.o with sigmoid diverticulae causing a stricture
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Pereira MC. Diverticular disease-associated colitis: Progression to severe chroni ulcerative colitis after sigmoid surgery. Gastrointest Endosc. 1998;48:520-3.
Rafferty J, Shellito P, Hyman NH, et al. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49:939-44.