Case 18 - Diverticulitis with intramural abscess

This young patient also has sigmoid diverticulitis.  There is a focal asymmetric area of sigmoid colon thickening.  There is little intra-abdominal fat but there is some stranding.  Don't be fooled by this patient's age.  Young people get diverticulitis.  You can see that she has other diverticula. 

Within the area of thickening there is a focus of hypoattenuation and air.  This is an early abscess.  However, unlike the other abscesses you have seen, this process appears to be centered in the bowel wall.  This is an intramural abscess. Intramural abscesses are cool because they self decompress into the lumen of the bowel.  Thus, they do not get large.  You would not place a drain into such a collection because then your drain would be in the wall of the bowel.

Click here for another case of diverticulitis with intramural abcess. Click here to return to the original case.

Before we finish, look at two things.  First, find the appendix.  Notice how tortuous it is.  The oral contrast makes it easy to follow.  Imagine trying to see this without oral contrast.  Secondly, don't get fooled by these bilateral adnexal multicystic masses.  This is a typical appearance of the ovaries in a premenopausal woman.  The multiple cysts represent normal follicular activity.