Acute Perforated Diverticulitis: Spectrum of MDCT Findings

Abstract

The perforation of an inflamed diverticula is a complication of the diverticular disease that requires early diagnosis and treatment.

MDCT, without bowel preparation, allows high-resolution multiplanar detection of diverticula perforation.

The spectrum of MDCT findings of the diverticula perforation depends on the site and on the entity of the lesion.

The most frequent perforation site is the sigmoid colon; the transverse colon accounted for 18 %, whereas perforation of the cecum and the right colon is rare (5 %).

In case of free perforation into the peritoneal cavity, MDCT has excellent contrast resolution to detect the presence of small amounts of free extraluminal air in close proximity to the intestinal wall thickening.

In the sigmoid, free perforation massive gas can occur in the pararenal spaces and progress through the diaphragm hiatus resulting in pneumomediastinum and cervical subcutaneous emphysema.

Because the diverticula extend into the pericolic fat, inflammation and subsequent inflammatory perforation usually lead to the pericolic inflammatory process with possible abscess. The diverticula perforation is usually covered and leads to local phlegmonous or abscess. Moreover, the inflammatory process can spread into adjacent organs as fistula.