Sigmoid Diverticulitis

Ultrasound, CT

A 63-year-old female patient presented with a two-day history of progressively worsening pain in the left lower quadrant. She had taken drotaverine independently without significant improvement.
Due to increasing pain, she sought medical attention and was referred from an outpatient clinic to the hospital emergency department.
The patient denied nausea, vomiting, bowel habit changes, and catarrhal symptoms.

In the region of the descending colon and sigmoid colon, a 9 mm diverticulum is visualized, containing hyperechoic content with posterior acoustic shadowing consistent with a fecalith.
The adjacent bowel segment demonstrates circumferential wall thickening up to 8 mm with preserved wall layer differentiation.
Increased echogenicity of the surrounding pericolic fat is observed, corresponding to inflammatory infiltration.

Ultrasound findings are consistent with acute sigmoid diverticulitis with inflammatory infiltration of the pericolic fat.

Circumferential thickening of the sigmoid colon wall up to 13 mm with multiple diverticula measuring up to 9 mm.
Inflammatory infiltration of the pericolic fat is present.
No signs of perforation, abscess formation, or free intraperitoneal gas are identified.

CT findings are consistent with acute sigmoid diverticulitis.

Colonic diverticular disease.
Acute sigmoid diverticulitis (Hinchey Ia) without signs of perforation or abscess formation.

The ultrasound appearance of diverticulitis may be misinterpreted as sigmoid colon malignancy, appendicitis (in cases of a long sigmoid colon), inflammatory bowel disease, or an infiltrative pelvic process.

Key points to consider:
-visualization of the inflamed diverticulum;
-focal tenderness during probe compression;
-inflammatory changes in the pericolic fat;
-preservation of the layered structure of the bowel wall;
-absence of a solid mass lesion.