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Sigmoid Diverticulitis

Value of Transrectal Sonography in Addition to Transabdominal Sonography

Alois Hollerweger1, Thomas Rettenbacher1, Peter Macheiner1, Walter Brunner2 and Norbert Gritzmann1

1 Department of Radiology and Nuclear Medicine, Hospital Barmherzige Brueder, Kajetanerplatz 1, A-5010 Salzburg, Austria.
2 Department of Surgery, Hospital Barmherzige Brueder, A-5010 Salzburg, Austria.



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  		Fig. 1. —Illustration of region can be shown on transrectal sonogram on barium enema (image sector is highlighted). Note that transrectal sonogram easily depicts lower sigmoid colon and rectosigmoidal junction.

 


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  		Fig. 2A. —57-year-old woman with acute diverticulitis of lower sigmoid colon. Transrectal sonogram shows thickened sigmoid colon with regular bowel wall layers (white arrows). Inflamed diverticulum contains shadowing fecalith (black arrows) that is centered in hyperechoic pericolic fat. Transabdominal sonography (not shown) gave false-negative interpretation.

 


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  		Fig. 2B. —57-year-old woman with acute diverticulitis of lower sigmoid colon. CT scan obtained immediately after A shows hyperdense diverticulum (long arrow) and increased density of peridiverticular fat (short arrows), confirming diverticulitis. Note that inflammation is located in region not readily accessible on transabdominal sonography

 


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  		Fig. 3A. —51-year-old man with mesocolic perforation. Transrectal sonogram shows thickened sigmoid segment (large arrows) with extensive gas collection outside colon (small arrows).

 


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  		Fig. 3B. —51-year-old man with mesocolic perforation. CT scan obtained immediately after A reveals definite extension of mesocolic perforation (arrows). This determination is not possible with transrectal sonography.

 


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  		Fig. 4. —Intramural abscess in 72-year-old woman. Transrectal sonogram shows focal hypoechoic lesion with strong hyperechoic internal echoes (small arrows) confined to wall of sigmoid colon (large arrows). This lesion, measuring 2.2 cm, was interpreted to represent small intramural abscess.

 


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  		Fig. 5A. —Perisigmoidal abscess in 59-year-old woman. Transabdominal sonogram shows marked hypoechoic wall thickening of sigmoid colon (arrows) not distinguishable from colonic cancer.

 


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  		Fig. 5B. —Perisigmoidal abscess in 59-year-old woman. Longitudinal (B) and transverse (C) transrectal sonograms of same segment as A show regular bowel wall layers of sigmoid colon (large arrows) and hypoechoic pericolic formation (small arrows). Note that with graded compression internal echoes of this formation were movable and indicated pericolic abscess.

 


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  		Fig. 5C. —Perisigmoidal abscess in 59-year-old woman. Longitudinal (B) and transverse (C) transrectal sonograms of same segment as A show regular bowel wall layers of sigmoid colon (large arrows) and hypoechoic pericolic formation (small arrows). Note that with graded compression internal echoes of this formation were movable and indicated pericolic abscess.

 


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  		Fig. 6. —Perisigmoidal abscess in 64-year-old man. Transrectal sonogram shows 4.5-cm hypoechoic fluid collection (small arrows) with bright internal echoes adjacent to sigmoid colon (large arrows). Surgery confirmed perisigmoidal abscess.

 

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