0:00

Okay, here we go.

0:02

Contrast-enhanced CT scan of the abdomen and pelvis.

0:05

On these upper cuts, I already noticed

0:06

something abnormal here in the anterior abdomen.

0:09

Let's look at this on lung windows.

0:12

Here we have free air in the upper abdomen.

0:15

Um, I told you on our case of the midline

0:17

abdominal pain that we were going to roll

0:19

the dice on whether or not, um, it was

0:21

upper tract disease or lower tract disease.

0:23

So we already saw upper tract disease.

0:25

This is an older patient, so we may gamble

0:28

on a lower tract cause for this perforation,

0:32

let's bring it to soft tissue windows.

0:35

And so we're going to gamble on

0:36

being diverticulitis perforation.

0:38

So as we come down to the left lower quadrant,

0:40

indeed we see a region of diverticulitis

0:42

with a lot of thickening of the colon,

0:44

numerous diverticulum of the colon as well.

0:47

And here we have just that one diverticulum

0:50

that must have perforated, and we see a small

0:52

locules of free air extending from the colon there.

0:55

So this is a case of diverticulitis leading to

0:59

perforation, so this is perforated diverticulitis.

1:03

You'd also want to see if there's any drainable fluid

1:04

collections, but either way, this is frequently a

1:06

surgical intervention because of the free extension

1:10

of fluid and feculent material within the peritoneum.

1:14

Let's go coronal on this.

1:15

I do frequently like to look at coronal for my colon

1:18

when I do my search patterns because you could run

1:20

the whole colon much faster on the coronals than you

1:22

can on the axials, but it's also a beautiful view

1:25

of this perforation, that thickening of the colon

1:29

here at that classic descending sigmoid junction.

Case: Diverticulitis With Free Air

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