A patient presents with mild abdominal pain and fluctuating bowel habits. The barium enema shows in PLATE R-39. What Is your diagnosis?
ANSWER: (D) DiverticulosisREF: Sutton 7th ed vol 1 page 645See PLATE R-39 KEY PLATE R-39 KEYDIVERTICULAR DISEASE: Diverticulosis & DiverticulitisDiverticulosis: Mucosal herniation through vascular entry sites into the pericolic fat often between the mesenteric and antimesenteric taeniae.Diverticulitis: Superimposed inflammation on diverticulosis DIVERTICULOSIS: Commonest cause of lower GI bleeding(A) Diverticulosis specimen: A section of colon reveals numerous diverticula which protrude from the edge of the taenia coli US: Abnormal wall thickening of more than 4 mm involving a segment 5 cm or longer at the point of maximal tenderness.(B) Barium enema: Lower GI showing Diverticula as flask like rounded out pouchings (arrow'). Distribution and severity is best demonstrated on barium enema. They produce ring shadow when seen en face. Differentiation from polyps is done on the basis of projection beyond the bowel wall and presence of air fluid level. Muscular changes results in Concertina like or Serrated appearance.(C) Diverticulitis With Abscess: Diverticulitis is a condition that occurs when diverticula become infected and inflamed. Complications of diverticulitis are Abscess, Bleeding, Fistula, Obstruction, Perforation. White arrowheads: Diverticula, White arrow: Narrowed lumen, Black arrow: Perforation with intramural abscess(D) CT scan: Arrowheads point to multiple diverticula arising from the recto sigmoid. CT is the imaging procedure of choice to evaluate diverticular disease, as it can show many aspects of disease that are net recognizable by other studies. CT scan can assess complications better. For inflammation or abscess, helical CT with colonic contrast has a sensitivity and specificity of 97 and 100%.CT BASED CLASSIFICATION OF DIVERTICULITISStage 0Mural thickeningStage 1Abscess/phlegmon <3 cm in diameterStage 2Abscess 5-15 cm in diameterStage 3Abscess beyond confines of pelvisStage 4Fecal peritonitis
Stricture colon
IBD
Toxic megalcolon
Diverticulosis
Abdominal Radiography