Presentation
Two days of worsening left iliac fossa pain. Bowels not open. Previous diverticulitis.
Patient Data
There is circumferential colonic wall thickening of the sigmoid colon secondary to acute diverticulitis. Medially a fistula extends to the urinary bladder where there is a thickened left lateral wall (18 mm thick) and gas within the bladder lumen. The fistula measures 16 mm AP and 18 mm transversely. The colon demonstrates moderate fecal loading throughout. No large or small bowel dilatation. No free fluid or free gas.
The liver is unremarkable apart from mild intra-fatty bile duct dilatation which is within normal limits given previous cholecystectomy. The CBD measures 13 mm. The kidneys, adrenal glands, pancreas, and spleen are unremarkable.
The major vessels are unremarkable. No lymphadenopathy.
The lung bases are clear. Mild multilevel degenerative disease of the lumbar spine.
Impression
Acute sigmoid diverticulosis complicated by a colovesical fistula. No free intraperitoneal gas or fluid.
Case Discussion
The patient had sigmoid colectomy and multiple CT-guided drains for post operative pericolic collections.
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