We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing's syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.
Abdominal Pain ; Aged ; Cushing Syndrome ; Diverticulitis* ; Diverticulum ; Humans ; Ultrasonography

An inflammation of an epiploic appendage is a relatively rare cause of acute abdominal pain. It can be clinically misdiagnosed as either acute appendicitis or diverticulitis. Judicious interpretation of imaging with ultrasound or computed tomography may lead to an early diagnosis and prevent unnecessary surgical or medical treatment. Conservative treatment of symptoms is usually sufficient. We have experienced a case of epiploic appendagitis treated by conservative management and report this case with the review of the literature.
Abdomen* ; Abdominal Pain ; Appendicitis ; Diverticulitis ; Early Diagnosis ; Inflammation ; Ultrasonography

With recent technical advances, increasing use of sonography in the initial evaluation of patients with abdominal disease may allow the detection of unexpected tumor within the abdominal cavity. Easiness of sonographic detection of bowel pathology, purposely or unexpectedly, warrants the inclusion of bowel loops during ultrasound examination when a patient complains of symptoms indicating diseases of the bowel. In patients complaining of acute abdominal symptoms or nonspecific gastrointestinal symptoms and showing signs such as abdominal pain, diarrhea, hematochezia, change of bowel habit, or bowel obstruction, sonography may reveal the primary causes and may play a definitive role in making a diagnosis. On ultrasonography, abnormal lesions may appear as fungating mass with eccentrically located bowel lumen (pseudokidney sign) or symmetrical or asymmetrical, encircling thickening of the colonic wall (target sign). In patients with mass or wall thickening detected on ultrasonography, additional work-up such as barium study, CT or endoscopy would be occasionally necessary for making a specific diagnosis.
Abdomen, Acute/ultrasonography ; Aged ; Appendicitis/ultrasonography ; Colorectal Neoplasms/ultrasonography ; Diverticulitis/ultrasonography ; Female ; Gastrointestinal Diseases/ultrasonography+ACo- ; Gastrointestinal Neoplasms/ultrasonography ; Human ; Inflammatory Bowel Diseases/ultrasonography ; Intestinal Obstruction/ultrasonography ; Intestinal Perforation/ultrasonography ; Intestines/ultrasonography ; Male ; Stomach/ultrasonography ; Ultrasonography/instrumentation

During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complication. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-up in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examination in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examination in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis(n=5) and perforated appendicitis(n=1). Our results show that high-resolution, real-time US is an accureate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complication.
Abscess ; Adenocarcinoma ; Appendicitis* ; Appendix ; Diagnosis* ; Diverticulitis ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ultrasonography*

Colovesical fistulae secondary to diverticulitis usually manifest themselves as non-specific lower abdominal discomfort and urologic symptoms. CT is known to be the most sensitive modality for diagnosing this entity. Ultrasonography is the initial diagnostic tool used for evaluating patients with these symptoms, but there have been no reports describing the ultrasonographic findings of colovesical fistulae in Korea. Therefore, we present a case of an ultrasonographically diagnosed colovesical fistula complicating sigmoid diverticulitis. Color Doppler ultrasonography was used in conjunction with lower abdominal compression in order to determine if the fistulous tract was open or obliterated.
Colon ; Colon, Sigmoid ; Diverticulitis ; Fistula ; Humans ; Intestinal Fistula ; Korea ; Ultrasonography, Doppler, Color ; Urinary Bladder

We describe a rare case of terminal ileal diverticulitis in a 68-year-old female with a day of history of right lower quadrant pain and tenderness, mimicking acute appendicitis. Ultrasonography revealed small sac-like out-pouching lesions with increased echogenicity of surrounding fat in thickened terminal ileum, suggesting inflamed diverticula. We diagnosed terminal ileal diverticulitis primarily by ultrasonography. The diagnosis was confirmed by subsequent computed tomography.
Aged ; Appendicitis ; Diagnosis ; Diverticulitis* ; Diverticulum ; Female ; Humans ; Ileum* ; Tomography, X-Ray Computed ; Ultrasonography*

PURPOSE: Colonic diverticulitis with right lower quadrant pain presents clinical symptoms and signs indistinguishable from those of appendicitis. This study was conducted to evaluate the clinical features, the laboratory findings, and the usefulness of sonography as a diagnostic tool forcolonic diverticulitis. METHODS: A total of 561 patients with acute right lower quadrant pain was referred for ultrasound (US) examination. The US studies were performed with a 4.0-to 8.0-MHzlinear transducer and an 8.0-to 5.0-MHz convex transducerusing the graded compression method. Thirty-seven (37)patients were finally diagnosed to have diverticulitis. We retrospectively evaluated the age distribution, the sex ratio, the clinical symptoms, the duration of illness before hospital adimission, and the US findings for those 37 patients. RESULTS: The average age of the patients was 33+/-16.1 years old. The ratio of males to females was 1.1 : 1. The mean duration of illness prior to seeking medical attention was 49.2+/-9.3 hours. Nausea, vomiting, and anorexia were seen in 29.7%, 10.8%, and 27.0% of the patients, respectively. Sonography detected 30 patients with diverticulitis with 2 false positive and 7 false negative results. The most typical sonographic feature of an inflamed diverticulum was a round or oval-shaped hypoechoic structure (86.5%) protruding from the colonic wall. Regional pericolic or peridiverticular fat thickening was noted in 81.1% of the patients, and segmental colon wall thickening in 70.8%. US examination yielded a sensitivity of 81.1%, a specificity of 99.6%, an overall accuracy of 98.4%, a positive predictive value of 93.7%, and a negative predictive value of 98.7%. CONCLUSION: This study will be useful in the diagnosis of right colonic diverticulitis, in particular, by using abdominal sonograms in patients who have atypical clinical symptoms or signs of appendicitis.
Age Distribution ; Anorexia ; Appendicitis ; Colon ; Diagnosis ; Diverticulitis* ; Diverticulitis, Colonic ; Diverticulum ; Female ; Humans ; Male ; Nausea ; Retrospective Studies ; Sensitivity and Specificity ; Sex Ratio ; Transducers ; Ultrasonography* ; Vomiting

PURPOSE: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality. METHODS: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics. RESULTS: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086). CONCLUSIONS: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Colon* ; Diagnosis* ; Diverticulitis* ; Diverticulitis, Colonic ; Diverticulum ; Enema ; Follow-Up Studies ; Humans ; Laparotomy ; Length of Stay ; Lost to Follow-Up ; Recurrence ; Retrospective Studies ; Ultrasonography

PURPOSE: To investigate the CT findings of acute right colonic diverticulitis, and to determine the differencebetween these and published reports deseribing left colonic, especially sigmoid, diverticulitis. MATERIAL AND METHODS: In 13 patients with acute right lower quadrant pain who underwent ultrasonography a normal appendix wasdemonstrated and acute right colonic diverticulitis was suspected. CT was performed within 24 hours and thefindings were analysed by two radiologists. For further confirmation of diverticulitis, follow-up barium enemaswere performed in ten patients. RESULTS: Inflamed diverticula were visible in all cases, and were solitary. Ninecases occured in the ascending colon and four in the cecum; in particular, eleven occurred around the ileocecalvalve. In three cases, the inflamed diverticulum was less than 1cm in diameter;in five cases, 1-2cm;in three,2-3cm, and in two, 3-4cm. These were able to be classified into two major forms. In three cases it was nodularwith hyperattenuation and some inhomogeneity, and ten shows the target form with thick walls and a central cavity.In five of these target lesions, the wall pattern was partially or completely inhomogenous, or multilayered. Thematerials filling the central cavity were gas in five cases, fecalith in two, and fluid in three. Abnormalpericoloic fat infiltrations were seen in twelve cases(92%), segmental colonic wall thickening in eleven(85%),other not-inflamed diverticula in five(38%), mesenteric lymph node enlargement in three(23%), free pericecal fluidcollection in three(23%), and perirenal fascial thickenings in two(15%). The complications such as remote abscesscavity, colonic obstruction, fistula or perforation were not found. On barium colon study, diverticulitis was inall cases confirmed by the presence of barium in the deformed diverticulum. CONCLUSION: Among CT findings foracute right colonic diverticulitis, the most important and pathognomonic is inflamed diverticula; the forms ofthese vary, and include gangrenous diverticulitis. The CT findings of early right colonic diverticulitis inKoreans might not, however, reveal the complications which sigmoid diverticulitis frequently involves; in patientswith right lower quadrant pain imaging studies are performed promptly, and for the mesentery, the anatomical basebetween right and left colons is different.
Appendix ; Barium ; Cecum ; Colon* ; Colon, Ascending ; Colon, Sigmoid ; Diverticulitis ; Diverticulitis, Colonic* ; Diverticulum ; Fecal Impaction ; Fistula ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mesentery ; Ultrasonography

Although toothpick ingestion is rare, it can lead to fatal complications in the gastrointestinal tract. Diagnosing toothpick ingestion is difficult because most patients do not recall swallowing one. We report 2 cases of toothpick-ingestion-induced colon injury, mimicking diverticulitis. The first patient was a 47-year-old male who had received conservative treatment under the impression of his having diverticulitis in the cecum. Ultrasonography revealed a linear foreign body in the right lower abdomen; a subsequent laparoscopic examination revealed inflammation around the cecum, but no evidence of bowel perforation. A thorough investigation revealed a toothpick embedded in the subcutaneous fat and muscle layer of the lower abdominal wall; we removed it. The second patient was a 56-year-old male who had received conservative treatment under the impression of his having diverticulitis in the sigmoid colon. An explorative laparotomy revealed a toothpick piercing the sigmoid colon; we performed an anterior resection. Both patients were discharged without postoperative complications.
Abdomen ; Abdominal Wall ; Cecum ; Colon* ; Colon, Sigmoid ; Deglutition ; Diverticulitis ; Diverticulitis, Colonic* ; Eating ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Inflammation ; Laparotomy ; Male ; Middle Aged ; Postoperative Complications ; Subcutaneous Fat ; Ultrasonography