[Computed tomography (CT) of acute diverticulitis of the cecum and ascending colon].
Acute diverticulitis of the cecum and ascending colon, also called right-sided diverticulitis, represents a relatively rare disorder in the western hemisphere. Pseudodiverticula and, less frequently, solitary congenital diverticula are regarded as the underlying causes of acute diverticulitis. We report the helical CT findings in four patients with acute right-sided colonic diverticulitis. The CT was performed with a collimation of 8 mm, a pitch of 1.5 and an increment of 8 mm, and with variable administration of intravenous, oral and rectal contrast material. In two of the four patients, the acute diverticulitis was detected in the cecum and ascending colon, respectively. In two patients, the diagnosis could be confirmed during surgery and subsequent histologic examination of the resected specimen. On the initial CT studies, acute diverticulitis was correctly diagnosed in two patients and suspected in one patient without identifying an inflamed diverticulum. In one patient, the offending diverticulum in the ascending colon caused an inflammatory pseudotumor at the level of the ileocecal region. This process was initially mistaken as Crohn's disease. The CT diagnosis of a right-sided colonic diverticulitis is based on an inflamed diverticulum in the center of pericolic inflammatory changes and a preserved wall enhancement (target sign). Other CT findings, such as fatty pericolic infiltration and colon wall thickening, are rather non-specific and can also be found in a number of different ileocolic disorders, especially in colon cancer. In selected cases, the diagnosis can only be established by follow up CT after the pericolic infiltration has markedly subsided and an offending diverticulum has emerged.
Ferstl
F J
FJ
Radiologisch-Nuklearmedizinisches Zentrum am St. Theresienkrankenhaus Nürnberg. franz.ferstl@rpnl.de
Obert
R
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002429:Cecal Diseases / Q000000981:diagnostic imaging; D003082:Colectomy; D003108:Colonic Diseases / Q000000981:diagnostic imaging; D003424:Crohn Disease / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004238:Diverticulitis / Q000000981:diagnostic imaging; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D013997:Time Factors; D036542:Tomography, Spiral Computed / Q000379:methods