Diverticulosis / Diverticulitis

A section of colon reveals numerous diverticula which protrude from the edge of the taenia coli (*). The colon is cut in cross section revealing the diverticuli (contain feces) and the empty colonic lumen.

 

What is diverticulosis and what is diverticulitis?
  • Diverticulosis refers to blind pouches leading off the alimentary tract.
  • Diverticulitis refers to when diverticula become infected and inflamed.
What is the mode of clinical presentation of diverticulosis?
  • They are usually discovered incidentally.
  • Clinical presentation changes once there is a complication.
What are the potential complications of diverticula?
  • Inflammation (diverticulitis)
  • Chronic blood loss/rarely acute hemorrhage
  • Abdominal discomfort/constipation/diarrhea
What are the complications of diverticulitis?
  • Abscess
  • Bleeding
  • Fistula
  • Obstruction
  • Perforation
Pathology Imaging
Diverticula out pouching from colon Diverticula in lower GI and CT scan
Diverticulitis  

Facial infiltration of mesentery

 Facial infiltration of mesentery

 

 Ileus

Thickened bowel wall

 Thickened bowel wall
Complications  

Abscess

 Inflammatory Mass with air pockets

Perforation

 Air under diaphragm

Fistula with bladder or vagina

 Fistulous tracks

Bleeding

 Nuclear medicine GI bleeding study

Obstruction

 Large bowel obstruction

Diverticula

CT: Arrowheads point to multiple diverticula arising from the recto sigmoid. The contrast in diverticula is left over from previously administered  GI contrast.

 

Acute Diverticulitis: A section of colon reveals acute inflammation (hyperemia, swelling) of the serosa and pericolic fat.

Lower GI showing Diverticula

CT scan with GI contrast study showing findings of diverticulitis.

  • Arrowheads: Diverticula
  • White arrow: Narrowed lumen
  • Black arrow: Perforation with intramural abscess

Pneumoperitoneum

  • Arrowheads point to free air.
  • Arrows points to collection of fluid around bowel loops.
  • Black arrows point to pericolonic fascial infiltration.

 

Pneumoperitoneum secondary to perforation of diverticulum.