3. z
A patient Gul rehman presented to us With complaint of alternative
diarrhea and constipation from last 3months with abdominal pain and
nausea, The symptoms worsen day by day and not relieved with
medication.
No other associated history and co-morbidities noted.
→this medical physician advised CT Abdomen & pelvis with contrast
→ No previous Radiological investigation provided
9. z
2.Epidemiology
Diverticulosis is very common in westernized countries
and Found in order individuals At 40 years of age ~ 5% of population
have diverticula : At 60 years ~ 30% increasing to 50-80 % by the
age of 80
10. z
Etiology
. Peptic ulcers
. Sedentary life style
.high fat
. Irritatable bowel
.Low fiber diet predispose to diabetes
12. z
4.Clinical features
.Most often asymptomatic
.Symptoms are bloating stomach pain, chlis, abdmonial
camping, abdmonial tenderon,fever .
.Alternatively constipation and diarrhea
13. z
Alternating constipation and diarrhea
Diverticulitis or abscess
Most common case of rectal bleeding in patients >40 years
age
14. z
5.Imaging
General features
→ Best Diagnostic clue
Rounded or oval colonic wall outpouching
→Location
Primarily sigmoid colon, but may occur in any segment except rectum.
15. z
→ size
5-10mm in diameter
→ Morphology
Oval or rounded
Imaging Recommendation
→ Best imaging Tool
CT and braium Enema
16. z
→ Protocol advice
Good bowel preparation is necessary to avoid
misdiagnosis of poly vs diverticula on air .
Contrast barium enema
17. z
Fluoroscopic finding
→contrast Enema
1. Diverticula project out beyond wall of colon
2. circular muscle hypertrophy (myoclcosis coli) cause
irregularly spaced indentations and narrowing of lumen of
colon
3. Easier To distinguish colonic diverticula from polyp on
single contrast barium enema
18. z
4. Diverticula fills with barium on single contrast barium enema
5. Diverticulum with large Neck may resemble sessile polyp on air contrast
barium enema
23. z
→ saw_tooth appearance to the colon, with shortening of bowel, cronding Of
haustra and picket-fencing of folds
24. z
Radiographic findings
Radiography
→ ‘’Bubbly‘’ Appearance of sigmoid in 56% of cases
→ Associated with calcified pleboliths
→ Diverticula arise adjacent wall due to weakness in bowel wall de
to penetration of vasa rectea
26. z
CT findings
→outpouching (Diverticula) filled with air, stool or contrast agent.
→Mural thicknessing due to myoclcosis ( circular muscle hypertrophy)
usually >4mm
→ Cause irregular narrowing of colonic lumen
→ No pericolonic fluid, gas or fat standing
34. z
6. Treatment
Treatment depends on a host of factors especially patient
comorbidites and stage of disease
→ For localized disease ( stage 1 and 2 ) conservative treatment
→ If the abscess is large , then percutaneous Drainage under CT or us
may be beneficial
→ Stage 3and 4 disease requires emergency surgery