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Acute Left Colonic Diverticulitis: Can CT Findings Be Used to Predict Recurrence?

Pierre-Alexandre Poletti1, Alexandra Platon1, Olivier Rutschmann2, Karen Kinkel1, Vince Nyikus1, Serban Ghiorghiu3, Philippe Morel4, François Terrier1 and Christoph D. Becker1

1 Department of Radiology, University Hospital of Geneva, 24, rue Micheli-du-Crest, Geneva 14 1211, Switzerland.
2 Department of Internal Medicine, University Hospital of Geneva, Geneva 14 1211, Switzerland.
3 Present address: Spitalul Clinic Sf. Spiridon, University Gr. T. Popa, Iasi, Rumania.
4 Clinic/Policlinic of Visceral Surgery, University Hospital of Geneva, Geneva 14 1211, Switzerland.



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  		Fig. 1. —56-year-old woman admitted for first episode of acute diverticulitis. Transverse CT scan shows concentric wall thickening (arrow) of descending colon. Area of adjacent fatty infiltration (arrowheads) measured 90 cm2 and was seen on 6-cm craniocaudal extension, for total volume of 540 cm3. Patient underwent 10 days of IV antibiotic treatment and was discharged home free of symptoms. Patient relapsed 2 months later; she was readmitted to hospital for new antibiotic treatment and scheduled for elective surgery.

 


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  		Fig. 2. —48-year-old man admitted for acute diverticulitis. Axial CT scan shows wall thickening of horizontal aspect of sigmoid colon (arrowheads). Bubbles of extraintestinal gas (< 5 mm diameter) (arrow) are seen in area of fat infiltration. Diverticulitis resolved with nonoperative treatment.

 


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  		Fig. 3A. —76-year-old woman admitted for first episode of acute diverticulitis. She underwent nonoperative treatment with IV antibiotics. Her general condition improved initially, but she relapsed 8 days after admission. She underwent sigmoidectomy 3 months later. Transverse CT scan shows thickening (arrowheads) of wall of horizontal aspect of sigmoid colon with associated local fat infiltration (arrow).

 


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  		Fig. 3B. —76-year-old woman admitted for first episode of acute diverticulitis. She underwent nonoperative treatment with IV antibiotics. Her general condition improved initially, but she relapsed 8 days after admission. She underwent sigmoidectomy 3 months later. Transverse CT scan obtained 5 cm above A shows pocket of extraintestinal gas (>= 5 mm in diameter) (arrow) in infiltrated fat (arrowheads).

 


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  		Fig. 4. —89-year-old man admitted for first episode of acute diverticulitis. Transverse pelvic CT scan shows thickened wall of distal sigmoid colon with narrowed lumen, filled by thin strip of intraintestinal contrast media (arrowhead). Cavity containing air–fluid level corresponding to abscess (arrow) is located adjacent to thickened sigmoid segment. Patient underwent IV antibiotic treatment, and abscess was drained under CT guidance. General condition improved, and patient was discharged home 2 weeks later with normal clinical examination and normal WBC. Three months later, he was readmitted to hospital with perforation of sigmoid colon and massive pneumoperitoneum seen on CT examination (not shown). He underwent emergent sigmoidectomy with colostomy (Hartmann procedure) and died soon after surgery.

 


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  		Fig. 5. —85-year-old woman admitted for acute diverticulitis. She recovered with antibiotic therapy and had no recurrence of diverticulitis. CT scan shows free peritoneal fluid (arrows) in right paracolic gutter and in mesosigmoid; infiltration of perisigmoid fatty tissue (arrowheads) is also shown.

 

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