Diverticular abscess

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There is a 10-12 cm abscess cavity with an air-fluid level in the left flank. Immediately adjacent to the abscess is a loop of bowel affected by diverticular disease with signs of direct communication.

Therapeutic options are either to insert a drainage tube under CT or ultrasound guidance or to proceed to laparotomy. If there is a large fistulous communication, then the surgical option would be favoured. Although the origin of the abscess is probably diverticular, the differential diagnosis includes a perforating colonic tumour and Crohn's colitis.

Colonic diverticulosis is an acquired herniation of the colonic mucosa and submucosa through the muscle layers. It is a condition more prevalent in developed countries with up to 50% of individuals affected by the seventh decade. The aetiology is linked to a diet lacking in roughage. The sigmoid is most frequently affected.

Complications include diverticular haemorrhage, colonic diverticulitis (Table 2.2), abscess formation, perforation, fistula and colonic stricture formation (see Fig. 2.31).

Table 2.2 Colonic diverticulitis CT features

Diverticula often visible on CT as round oval focus protruding from

bowel wall (may fill with oral contrast)

Streaky peri-colic fat

Bowel wall thickening

Intestinal obstruction

Fluid or gas in peritoneum

Fistulation into

• Bladder (look for an air-fluid level)

• Small bowel/vagina/cutaneous

Abscess or peri-colic collection

Absess Colon

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