ACUTE PRESENTATION OF INTRAPERITONEAL ABSCESS: A DIAGNOSTIC DILEMMA

1. ACUTE PRESENTATION OF INTRAPERITONEAL ABSCESS: A
DIAGNOSTIC DILEMMA
SUJAY KUMAR DAS, LOKESH MEENA, SUNIL K.S, ANJUM SYED

2. INTRODUCTION
• The incidence of diverticular disease increases with age.
• The most common complication is diverticulitis which commonly results in
perforation of the colon, usually forming a local abscess.
• However, there can be development of a large intraperitoneal abscess which
produces acute obstructive symptoms due to mass effects.
• Emergent diagnosis by contrast-enhanced computed tomography (CECT) has
highest sensitivity.

3. MATERIALS AND METHODS
• We present a case of a 73 years old male who presented to the emergency
department with complaints of:
– Acute pain abdomen
– Abdominal distension
– Features of acute large bowel obstruction.
• There was past history of few episodes of per-rectal bleeding.
• There was no previous history of surgery, however previous CT scan done
few months back suggested sigmoid diverticulitis.

4. IMAGES: CECT abdomen: large thick
waled intraperitoneal collection with air-fluid
levels within, at upper abdomen adjacent to
transverse colon, abutting liver. Multiple
diverticula noted at transverse colon.
DIVERTICULUM
AXIAL SECTION
CORONAL SECTION
TRANSVERSE SECTION
INTRAPERITONEAL
COLLECTION WITH
AIR-FLUID LEVELS

5. IMAGES: CECT abdomen: large thick waled
intraperitoneal collection with air-fluid levels
within at pelvis displacing the sigmoid colon
posteriorly with its compression. Multiple
diverticula noted at sigmoid colon.
SIGMOID
DIVERTICULUM
AXIAL SECTION
CORONAL SECTION
TRANSVERSE SECTION
INTRAPERITONEAL
COLLECTION WITH
AIR-FLUID LEVELS
URINARY
BLADDER

6. TEACHING POINTS
• On initial USG, findings can be misinterpreted as dilated colonic loops.
• Emergent diagnosis of intraperitoneal abscesses post- large bowel
diverticular rupture can help in rapid treatment decisions.
• CECT abdomen is best modality to depict relation of the abscess with
bowel loops.
• Effective management by pigtail catheter insertion and drainage gives
immediate relief of symptoms.