Type:
Educational Exhibit
Keywords:
Inflammation, Diverticula, Diagnostic procedure, Ultrasound, CT, Gastrointestinal tract, Colon, Abdomen
Authors:
J. Ressurreição1, J. T. Soares2, L. Batista1, I. Marques3, A. Almeida1, P. Madaleno Ferreira Alves1, P. Portugal1, E. Matos1; 1Vila Nova de Gaia/PT, 2Madalena- Vila Nova de Gaia/PT, 3Vila Nova de Gaia, Porto/PT
DOI:
10.1594/ecr2013/C-1845
Background
Colonic diverticular disease (diverticulosis) is frequent in Western nations,
affecting more frequently the elderly.
However,
bad dietary habits adopted by young people,
low in fibers,
are responsible for an increase in the prevalence of diverticulosis in those younger than 40.
The great majority of colonic diverticula are acquired – pseudodiverticula ( Fig. 1 ),
representing small protrusions of colonic mucosa and submucosa through the muscularis propria,
occurring at the point where the vessels pierce the muscularis,
between the mesenteric and antimesenteric teniae.
These acquired diverticula are more frequent in the descending and sigmoid colon,
resulting from the increased intracolonic pressure in these areas compared with more proximal colonic segments.
They are generally multiple.
On the contrary,
congenital diverticula are true diverticula (Fig. 2 ),
involving all layers of bowel wall.
They are predominantly right sided and almost always solitary.
Congenital diverticula are quite rare.
Colonic diverticula are frequently seen in routine abdominal imaging studies,
especially at computed tomography (CT),
appearing like multiple air-filled outpouchings of the colonic wall (Fig. 3 ).
Diverticulitis,
the process of inflammation of a diverticulum,
is secondary to obstruction of the diverticular neck.
Lower abdominal pain and tenderness are the main symptoms of diverticulitis,
generally occurring in the left iliac fossa and hypogastrium as diverticula are mostly seen at the descending and sigmoid portions of the colon.
Low-grade fever with elevated white blood cell count usually follows these symptoms. As these are very unspecific findings and several other pathologies can present like this,
imaging studies,
namely ultrasonography (US) and CT are a precious help,
being able to assure the diagnosis,
to exclude (or confirm) other pathologies with diverticulitis-like presentation and also to evaluate the presence of complications associated to diverticular inflammation.