Ticking bomb in the abdomen..story of diverticular disease .

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Ticking bomb in the abdomen..story of diverticular disease .

  1. 1. Ticking bomb in the abdomen Dr/Ahmed Bahnassy Consultant Radiologist PSMMC
  2. 2. History 35 years old patient ,presented by abdominal pain ,and fever. Leucocitic count was high. MDCT was requested .
  3. 3. Sigmoid colon wal thickening fat stranding intense para colic inflammatory changes
  4. 4. abscess fistula
  5. 5. gas filled outpouchings
  6. 6. gas filled outpouchings
  7. 7. abscess fistula
  8. 8. Sigmoid colon wall thickening
  9. 9. para colic abscess
  10. 10. DD top diagnosis • • • • Diverticular disease . Crhon's disease. no skip lesions Perforated cancer colon. Ulcerative colitis . rectum is sparee young age
  11. 11. Final post operative diagnosis
  12. 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. 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. 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. 15. Stages of diverticular disease
  16. 16. Stages of diverticular disease
  17. 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.

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