1. Ticking bomb in the
abdomen
Dr/Ahmed Bahnassy
Consultant Radiologist
PSMMC

2. History
35 years old patient ,presented by
abdominal pain ,and fever.
Leucocitic count was high.
MDCT was requested .

3. Sigmoid colon wal
thickening
fat stranding
intense para colic
inflammatory changes

4. abscess
fistula

5. gas filled
outpouchings

6. gas filled
outpouchings

7. abscess
fistula

8. Sigmoid colon wall thickening

9. para colic abscess

10. DD
top diagnosis
•
•
•
•
Diverticular disease .
Crhon's disease.
no skip lesions
Perforated cancer colon.
Ulcerative colitis .
rectum is sparee
young age

11. Final post operative diagnosis

12. Diverticular disease
Diverticular disease includes a spectrum
of conditions ranging from asymptomatic
diverticular disease, to symptomatic
uncomplicated diverticular disease, and
complicated diverticular disease that
includes acute and chronic diverticulitis.

13. Diverticulitis
Diverticulitis is defined as an inflammation of
one or more diverticula, which are small
pouches created by herniation of mucosa
into the wall of the colon. Diverticulitis is
generally considered a disease of the
elderly, but as many as 20% of patients
with diverticulitis are younger than 50
years.

14. Fistulization
Fistula formation is a complication of diverticulitis. Fistulas
to adjacent organs and the skin may develop, especially
in the presence of an abscess.
In men, colovesicular fistulas are the most common.
In women, the uterus is interposed between the colon and
the bladder, and this complication is only seen following
a hysterectomy. The uterus precludes fistula formation
from the sigmoid colon to the urinary bladder. However,
colovaginal and colocutaneous fistulas can form but are
uncommon.

15. Stages of diverticular disease

16. Stages of diverticular disease

17. Note
SCAD(Segmental colitis
associated with diverticulitis).
SCAD is a unique form of chronic colitis limited
to areas of the colon with diverticular formation.
Gore et al. first reported on the presence of an
entity they termed “diverticular colitis”.
Often mistakenly diagnosed as either ulcerative
colitis or Crohn’s disease, patients typically
present with pain and intermittent rectal
bleeding.