eMedicine Specialties > Radiology > Gastrointestinal

Colon, Diverticulitis: Multimedia

Author: Sandor Joffe, MD, Section Chief of Abdominal Imaging, Department of Radiology, Beth Israel Medical Center
Coauthor(s): Aspasia Kachulis, MD, Body Imaging Fellow, Department of Radiology, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Aug 24, 2009

Multimedia

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Media file 1: CT scan demonstrates mild diverticulitis of the descending colon, with wall thickening, a diverticulum, and mild stranding of the pericolic fat.

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CT scan demonstrates mild diverticulitis of the descending colon, with wall thickening, a diverticulum, and mild stranding of the pericolic fat.

(Enlarge Image)

Media file 2: CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 3).

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CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 3).

(Enlarge Image)

Media file 3: CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 2).

[ CLOSE WINDOW ]

CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 2).

(Enlarge Image)

Media file 4: Single-contrast barium enema study demonstrates mild sigmoid diverticulitis with thickening of the mucosal folds and luminal narrowing.

[ CLOSE WINDOW ]

Single-contrast barium enema study demonstrates mild sigmoid diverticulitis with thickening of the mucosal folds and luminal narrowing.

(Enlarge Image)

Media file 5: CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid colon and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 6).

[ CLOSE WINDOW ]

CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid colon and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 6).

(Enlarge Image)

Media file 6: CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 5).

[ CLOSE WINDOW ]

CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 5).

(Enlarge Image)

Media file 7: CT scan in a patient with diverticulitis demonstrates an abscess adjacent to the sigmoid colon.

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CT scan in a patient with diverticulitis demonstrates an abscess adjacent to the sigmoid colon.

(Enlarge Image)

Media file 8: Single-contrast barium enema study in a patient with diverticulitis demonstrates tethering of the sigmoid colon as a result of a diverticular abscess.

[ CLOSE WINDOW ]

Single-contrast barium enema study in a patient with diverticulitis demonstrates tethering of the sigmoid colon as a result of a diverticular abscess.

(Enlarge Image)

Media file 9: Single-contrast barium enema study in a patient with diverticulitis demonstrates an intramural abscess filling with barium.

[ CLOSE WINDOW ]

Single-contrast barium enema study in a patient with diverticulitis demonstrates an intramural abscess filling with barium.

(Enlarge Image)

Media file 10: Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 11-12). Note the contrast enhancement in the bladder in Images 11-12.

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Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 11-12). Note the contrast enhancement in the bladder in Images 11-12.

(Enlarge Image)

Media file 11: Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-12). Note the contrast material in the bladder on Image 12.

[ CLOSE WINDOW ]

Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-12). Note the contrast material in the bladder on Image 12.

(Enlarge Image)

Media file 12: Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-11). Note the contrast material in the bladder in Image 11.

[ CLOSE WINDOW ]

Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-11). Note the contrast material in the bladder in Image 11.

(Enlarge Image)

Media file 13: Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip; this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

[ CLOSE WINDOW ]

Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip; this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

(Enlarge Image)

Media file 14: Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip; this was interpreted as necrotizing fasciitis (see Image 13). Gastrografin enema performed 8 days later demonstrated diverticulosis (this image) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

[ CLOSE WINDOW ]

Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip; this was interpreted as necrotizing fasciitis (see Image 13). Gastrografin enema performed 8 days later demonstrated diverticulosis (this image) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

(Enlarge Image)

Media file 15: Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (this image). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

[ CLOSE WINDOW ]

Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (this image). CT scan obtained 8 days later (see Images 16-17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

(Enlarge Image)

Media file 16: Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see this image and Image 17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

[ CLOSE WINDOW ]

Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see this image and Image 17) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

(Enlarge Image)

Media file 17: Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema examination performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Image 16 and this image) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

[ CLOSE WINDOW ]

Diverticulitis with fistula in the soft tissues of the thigh. The patient presented with air in the soft tissues surrounding the hip (see Image 13); this was interpreted as necrotizing fasciitis. Gastrografin enema examination performed 8 days later demonstrated diverticulosis (see Image 14) and extravasation from the colon into the thigh (see Image 15). CT scan obtained 8 days later (see Image 16 and this image) demonstrates diverticulitis of the descending colon with extension into the soft tissues of the abdominal wall and thigh.

(Enlarge Image)

Media file 18: Single-contrast barium enema study demonstrates sigmoid diverticulitis with an intramural sinus tract. Fistula formation in the small bowel is noted.

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Single-contrast barium enema study demonstrates sigmoid diverticulitis with an intramural sinus tract. Fistula formation in the small bowel is noted.

(Enlarge Image)

Media file 19: Single-contrast barium enema study demonstrates diverticulitis of the descending colon with fistula formation in the small bowel.

[ CLOSE WINDOW ]

Single-contrast barium enema study demonstrates diverticulitis of the descending colon with fistula formation in the small bowel.

(Enlarge Image)

Media file 20: Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the vagina.

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Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the vagina.

(Enlarge Image)

Media file 21: Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the cecum.

[ CLOSE WINDOW ]

Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the cecum.

(Enlarge Image)

Media file 22: CT scan demonstrates diverticulosis in a patient with colon carcinoma. Although the mass is somewhat eccentric, this type of case is difficult to differentiate from diverticulitis, and follow-up imaging is often necessary.

[ CLOSE WINDOW ]

CT scan demonstrates diverticulosis in a patient with colon carcinoma. Although the mass is somewhat eccentric, this type of case is difficult to differentiate from diverticulitis, and follow-up imaging is often necessary.

(Enlarge Image)

Media file 23: The CT image demonstrates a pericolic fat-attenuation mass with surrounding infiltration of the fat, which is characteristic of epiploic appendagitis.

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The CT image demonstrates a pericolic fat-attenuation mass with surrounding infiltration of the fat, which is characteristic of epiploic appendagitis.

More on Colon, Diverticulitis

Overview: Colon, Diverticulitis

Imaging: Colon, Diverticulitis

Follow-up: Colon, Diverticulitis

Multimedia: Colon, Diverticulitis

References

Balthazar EJ. Diverticular disease. In: Textbook of Gastrointestinal Radiology. WB Saunders Co;1994: 1072-97.
Tonelli F, Di Carlo V, Liscia G, Serventi A. [Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]. Ann Ital Chir. Jan-Feb 2009;80(1):3-8. [Medline].
Sarma D, Longo WE. Diagnostic imaging for diverticulitis. J Clin Gastroenterol. Nov-Dec 2008;42(10):1139-41. [Medline].
Sheiman L, Levine MS, Levin AA, Hogan J, Rubesin SE, Furth EE, et al. Chronic diverticulitis: clinical, radiographic, and pathologic findings. AJR Am J Roentgenol. Aug 2008;191(2):522-8. [Medline].
Panghaal VS, Chernyak V, Patlas M, Rozenblit AM. CT features of adnexal involvement in patients with diverticulitis. AJR Am J Roentgenol. Apr 2009;192(4):963-6. [Medline].
Beuran M, Iordache F, Chiotoroiu AL, Teleanu G, Vartic M, Turculet C, et al. Complicated diverticular disease--our recent experience. Chirurgia (Bucur). Jan-Feb 2009;104(1):25-9. [Medline].
Heise CP. Epidemiology and Pathogenesis of Diverticular Disease. J Gastrointest Surg. Feb 16 2008;[Medline].
Belmonte C, Klas JV, Perez JJ, et al. The Hartmann procedure. First choice or last resort in diverticular disease?. Arch Surg. Jun 1996;131(6):612-5; discussion 616-7. [Medline].
Tursi A, Brandimarte G, Giorgetti G, Elisei W, Maiorano M, Aiello F. The Clinical Picture of Uncomplicated Versus Complicated Diverticulitis of the Colon. Dig Dis Sci. Jan 30 2008;[Medline].
Stefansson T, Nyman R, Nilsson S, et al. Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy. Acta Radiol. Mar 1997;38(2):313-9. [Medline].
Rao PM, Rhea JT, Novelline RA, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol. Jun 1998;170(6):1445-9. [Medline].
Jang HJ, Lim HK, Lee SJ, et al. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol. May 2000;174(5):1397-402. [Medline].
Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics. Mar-Apr 2000;20(2):399-418. [Medline].
Rao PM, Rhea JT. Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis. Radiology. Dec 1998;209(3):775-9. [Medline].
Cho KC, Morehouse HT, Alterman DD, Thornhill BA. Sigmoid diverticulitis: diagnostic role of CT--comparison with barium enema studies. Radiology. Jul 1990;176(1):111-5. [Medline].
Chintapalli KN, Chopra S, Ghiatas AA, et al. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology. Feb 1999;210(2):429-35. [Medline].
Hollerweger A, Rettenbacher T, Macheiner P, et al. Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography. AJR Am J Roentgenol. Oct 2000;175(4):1155-60. [Medline].
Kori T, Nemoto M, Maeda M, et al. Sonographic features of acute colonic diverticulitis: the "dome sign". J Clin Ultrasound. Sep 2000;28(7):340-6. [Medline].
Oudenhoven LF, Koumans RK, Puylaert JB. Right colonic diverticulitis: US and CT findings--new insights about frequency and natural history. Radiology. Sep 1998;208(3):611-8. [Medline].
Pradel JA, Adell JF, Taourel P, et al. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology. Nov 1997;205(2):503-12. [Medline].
Hussain A, Mahmood H, Subhas G, El-Hasani S. Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England. World J Emerg Surg. 2008;3:5. [Medline].
Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol. Sep 2007;22(9):1360-8. [Medline].
Kassab A, El-Bialy G, Hashesh H, Callen P. Magnetic resonance imaging and hysteroscopy to diagnose colo-uterine fistula: A rare complication of diverticulitis. J Obstet Gynaecol Res. Feb 2008;34(1):117-20. [Medline].

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Keywords

diverticulitis, diverticulum, diverticulosis, diverticular disease, diverticular disease of the colon, outpouching, diverticula, colonic diverticula, intestinal disease, diverticular hemorrhage, bowel obstruction, gastrointestinal hemorrhage, GI tract hemorrhage

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Contributor Information and Disclosures

Author

Sandor Joffe, MD, Section Chief of Abdominal Imaging, Department of Radiology, Beth Israel Medical Center
Sandor Joffe, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Aspasia Kachulis, MD, Body Imaging Fellow, Department of Radiology, Beth Israel Medical Center
Aspasia Kachulis, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

John L Haddad, MD, Clinical Associate Professor, Department of Radiology, Weill Medical College of Cornell University; Director of Body MRI, Department of Radiology, Methodist Hospital in Houston
John L Haddad, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Gastrointestinal

Colon, Diverticulitis: Multimedia

Multimedia

CT scan demonstrates mild diverticulitis of the descending colon, with wall thickening, a diverticulum, and mild stranding of the pericolic fat.

CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 3).

CT scan demonstrates typical sigmoid diverticulitis with wall thickening, diverticulosis, and stranding at the root of the sigmoid mesentery (same patient as in Image 2).

Single-contrast barium enema study demonstrates mild sigmoid diverticulitis with thickening of the mucosal folds and luminal narrowing.

CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid colon and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 6).

CT scan in a patient with diverticulitis demonstrates an intramural abscess in the sigmoid and an abscess adjacent to the rectosigmoid that fills with contrast material (same patient as in Image 5).

CT scan in a patient with diverticulitis demonstrates an abscess adjacent to the sigmoid colon.

Single-contrast barium enema study in a patient with diverticulitis demonstrates tethering of the sigmoid colon as a result of a diverticular abscess.

Single-contrast barium enema study in a patient with diverticulitis demonstrates an intramural abscess filling with barium.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 11-12). Note the contrast enhancement in the bladder in Images 11-12.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-12). Note the contrast material in the bladder on Image 12.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with a colovesical fistula (same patient as in Images 10-11). Note the contrast material in the bladder in Image 11.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with an intramural sinus tract. Fistula formation in the small bowel is noted.

Single-contrast barium enema study demonstrates diverticulitis of the descending colon with fistula formation in the small bowel.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the vagina.

Single-contrast barium enema study demonstrates sigmoid diverticulitis with fistula formation in the cecum.

CT scan demonstrates diverticulosis in a patient with colon carcinoma. Although the mass is somewhat eccentric, this type of case is difficult to differentiate from diverticulitis, and follow-up imaging is often necessary.

The CT image demonstrates a pericolic fat-attenuation mass with surrounding infiltration of the fat, which is characteristic of epiploic appendagitis.

More on Colon, Diverticulitis

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor