Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Feb;8(1):19-27.
doi: 10.1007/s13244-016-0532-3. Epub 2016 Nov 22.

Diverticulitis: a comprehensive review with usual and unusual complications

Mehmet Ruhi Onur  1   2 , Erhan Akpinar  3   4 , Ali Devrim Karaosmanoglu  3   4 , Cavid Isayev  3   4 , Musturay Karcaaltincaba  3   4
Affiliations
Review

Diverticulitis: a comprehensive review with usual and unusual complications

Mehmet Ruhi Onur et al. Insights Imaging. 2017 Feb.

Abstract

Diverticulitis is characterized by inflammation of the outpouchings of the bowel wall. Imaging findings of diverticulitis include edematous thickening of the bowel wall with inflammatory changes within the adjacent mesenteric fat. Uncomplicated diverticulitis can be treated conservatively; however, complicated diverticulitis may not be responsive to medical treatment and life-threatening conditions may occur. In this review, we aimed to illustrate the ultrasonography (US) and computed tomography (CT) features of diverticulitis and its complications including perforation, phlegmon, abscess, ascending septic thrombophlebitis (phylephlebitis), bleeding, intestinal obstruction, and fistula.

Teaching points: • Complications of diverticulitis may be highly variable. • It may be difficult to diagnose diverticulitis as underlying cause of severe complications. • MDCT is essential for the primary diagnosis of the acute diverticulitis and its complications.

Keywords: Complication; Computed tomography; Diverticulitis; Pylephlebitis; Ultrasonography.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Thirty-eight year-old male with diverticulitis and well-contained perforation. Axial contrast-enhanced CT demonstrates edema and thickening of the sigmoid colon wall with multiple diverticulums. A fluid collection adjacent to the sigmoid colon (arrows) is an abscess caused by perforation of the diverticulitis. Free air pockets (arrowhead) confined to the pericolonic region are seen
Fig. 2
Fig. 2
Seventy-two-year-old female with free perforation complicating diverticulitis. Axial contrast enhanced CT images at parenchymal window (a) and bone window (b) demonstrate a ‘dirty mass’ (arrows) formed by stool nearby sigmoid colon diverticulitis. Free air (arrowheads) and inflammatory fat stranding resulting from perforation of diverticulitis are seen posterior to the pararenal fascia
Fig. 3
Fig. 3
Phlegmon in a 38-year-old female with diverticulitis. a Endovaginal US reveals diffuse thickening and edema of the rectum and sigmoid colon mucosa (*) and muscular wall (arrow). b A diverticulum (arrow) with wall thickening, hyperechoic content (fecalith) and surrounding edematous fat tissue represents diverticulitis. c Axial contrast-enhanced CT of the same patient demonstrates multiple diverticulum with wall edema in distal sigmoid colon (arrow) and pericolonic fat stranding (arrowheads) representing diverticulitis. d Axial contrast-enhanced CT image at the superior level reveals a phlegmon with a hyperattenuating appearance (arrow) compared to adjacent pelvic fat
Fig. 4
Fig. 4
Abscess resulting from a diverticulitis in an 85-year-old female. a Endovaginal US demonstrates a fluid collection with gas content and wall thickening (arrows) representing abscess. b Axial contrast-enhanced CT image reveals diverticulitis with edematous sigmoid colon, multiple diverticulum and surrounding fat stranding (arrow). c Axial contrast-enhanced CT of the same patient demonstrates a pelvic abscess (arrows) with enhancing wall and air content in a Douglas pouch
Fig. 5
Fig. 5
Liver abscess in a 48-year-old male after diverticulitis. a Axial CT demonstrates diverticulitis (arrow) in the sigmoid colon. b Liver abscess secondary to diverticulitis. Gray-scale US demonstrates a liver abscess with a hypoechoic, solid mass appearance (arrow) in the liver parenchyma. c Liver abscesses manifest with low-attenuating, ill-defined appearance (arrows) in the liver parenchyma on axial contrast-enhanced CT
Fig. 6
Fig. 6
Sixty-year-old male presenting with diverticulitis and IMV thrombosis. a Axial contrast-enhanced CT image demonstrates thickening of sigmoid colon wall (arrow) with multiple diverticulum. b Axial and coronal c contrast-enhanced CT images reveal thrombus in the IMV (arrows) with adjacent fat stranding representing thrombophlebitis
Fig. 7
Fig. 7
Pulmonary septic emboli in a 58-year-old male resulting from diverticulitis. a Axial contrast-enhanced CT of a 58 year-old man demonstrates edema and thickening of the sigmoid colon wall (arrow) with diverticulum and adjacent fat stranding. b Axial contrast-enhanced CT reveals thrombosis (arrow) in the inferior vena cava lumen. c Axial contrast-enhanced CT image at lung window setting shows multiple cavitary lesions (arrows) with thick wall representing septic emboli
Fig. 8
Fig. 8
Intestinal obstruction in a 79-year-old male secondary to diverticulitis. a Axial contrast-enhanced CT of a 75-year-old man presenting with abdominal pain and distention reveals a diverticulitis with the appearance of a inflamed diverticulum and pericolonic fat stranding (arrow) in the transverse colon. Bowel segments proximal to the localization of diverticulitis is dilated. b Axial CT performed 2-months after the first CT reveals thickening of the colonic wall (arrow) leading to intestinal obstruction
Fig. 9
Fig. 9
Bleeding diverticulitis in a 70-year-old male. a Axial contrast-enhanced CT of a 70-year-old man without oral contrast agent administration reveals intraluminal high attenuating contrast agent leakage (arrowhead) in transverse colon. b Axial contrast- enhanced CT at venous phase demonstrates increased contrast amount in the lumen (arrow) indicating active hemorrhage. c Oblique reformatted CT image reveals feeding artery (arrow) of the diverticulitis and contrast extravasation (arrowhead)
Fig. 10
Fig. 10
Colovesical fistula in a 46-year-old male after diverticulitis. a Axial contrast-enhanced CT of a 62-year-old woman reveals a fluid collection (arrows) in the Douglas pouch with air content and peripherally enhancing wall. b Contrast-enhanced CT reveals thickening of left bladder wall (arrow) adjacent to the diverticulum. c Coronal contrast-enhanced CT performed 5 months after first CT demonstrates a fistula (arrow) between the sigmoid colon and the bladder
See this image and copyright information in PMC

References

    1. Sebbane M, Dumont R, Jreige R, Eledjam JJ. Epidemiology of acute abdominal pain in adults in the emergency department setting. In: Taourel P, editor. CT of the acute abdomen. Berlin Heidelberg: Springer; 2011. pp. 3–13.
    1. Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998;338:1521–1526. doi: 10.1056/NEJM199805213382107. - DOI - PubMed
    1. Puylaert JB. Ultrasound of colon diverticulitis. Dig Dis. 2012;30:56–59. doi: 10.1159/000336620. - DOI - PubMed
    1. Werner A, Diehl SJ, Farag-Soliman M, et al. Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol. 2003;13:2596–2603. doi: 10.1007/s00330-003-1887-7. - DOI - PubMed
    1. Stoker J, van Raden A, Lameris W, et al. Imaging patients with acute abdominal pain. Radiology. 2009;253:31–46. doi: 10.1148/radiol.2531090302. - DOI - PubMed

LinkOut - more resources