{"id":1841,"date":"2020-10-28T08:00:00","date_gmt":"2020-10-28T08:00:00","guid":{"rendered":"https:\/\/emultrasound.sdsc.edu\/?p=1841"},"modified":"2021-01-18T20:57:14","modified_gmt":"2021-01-18T20:57:14","slug":"diverticulitis-abscess","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/10\/28\/diverticulitis-abscess\/","title":{"rendered":"Case 24: Diverticulitis"},"content":{"rendered":"<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12 mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<p style=\"text-align: center;\">&nbsp;<\/p>\n<p dir=\"ltr\" style=\"text-align: center;\">A 56 year old male with a history of uncomplicated diverticulitis presented to the emergency room with left lower quadrant pain and loose stools for the last six days. He denies fever, vomiting or blood in hist stool&nbsp;<\/p>\n<p dir=\"ltr\" style=\"text-align: center;\">Vitals: T 97.3 &nbsp; BP 152\/81 &nbsp; HR 91 &nbsp; &nbsp; &nbsp; RR 18&nbsp; &nbsp; &nbsp; SPO2 97% on RA<\/p>\n<p dir=\"ltr\" style=\"text-align: center;\">&nbsp;<\/p>\n<p dir=\"ltr\" style=\"text-align: center;\">You physical exam shows tenderness to palpation in the left lower quadrant with no peritoneal signs. You are on the fence about getting a CT abdomen and pelvis with contrast to look for an abscess versus treating this as uncomplicated diverticulitis. You decide to throw the ultrasound probe on the area of his pain. What do we see in these images? How would this change management?<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12 mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-video-obj\"><iframe src=\"\/\/www.youtube.com\/embed\/eYNgYL7DqM0?wmode=opaque\" class=\" mpce-dsbl-margin-left mpce-dsbl-margin-right mpce-dsbl-margin-top mpce-dsbl-margin-bottom\" frameborder=\"0\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12 mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-video-obj\"><iframe src=\"\/\/www.youtube.com\/embed\/L5EY9I7TQ1E?wmode=opaque\" class=\" mpce-dsbl-margin-left mpce-dsbl-margin-right mpce-dsbl-margin-top mpce-dsbl-margin-bottom\" frameborder=\"0\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12 mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-video-obj\"><iframe src=\"\/\/www.youtube.com\/embed\/EUtP-iKrldc?wmode=opaque\" class=\" mpce-dsbl-margin-left mpce-dsbl-margin-right mpce-dsbl-margin-top mpce-dsbl-margin-bottom\" frameborder=\"0\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-prvt-517-59604dcdd5a2a mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj mpce-prvt-517-5960471ed59dc motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Answer and Learning Points<\/h3><div>\n<p class=\"p1\" style=\"text-align: center;\"><strong><span class=\"s1\">Answer: <\/span><\/strong><\/p>\n<p>The three videos and two images show diverticulitis with an abscess or phlegmon beneath the bowel loops. Though CT is the gold standard for diagnosing diverticulitis, ultrasound is relatively sensitive in the diagnosis and has the advantage of being cheap, fast and radiation-free (1).\u00a0<\/p>\n<p>When looking for diverticulitis on ultrasound physicians will typically use a \"lawn mower\" approach to the left abdomen to search for areas of affected bowel. One way to get to the area of interest more quickly is simply ask the patient to point to the area of maximal tenderness and start there, similar to appendicitis or small bowel obstruction. There are a few findings on ultrasound that indicate diverticulitis (2,3):<\/p>\n<ol>\n<li>Thickening of bowel wall, typically at least 4-5mm<\/li>\n<li>Echogenic fat surrounding the bowel, which is representative of fat stranding seen on CT<\/li>\n<li>Diverticulum<\/li>\n<\/ol>\n<figure id=\"attachment_1852\" aria-describedby=\"caption-attachment-1852\" style=\"width: 724px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-1852 size-full\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2020\/10\/wall-thickening.jpg?resize=525%2C367&#038;ssl=1\" alt=\"diverticulitis ultrasound\" width=\"525\" height=\"367\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/wall-thickening.jpg?w=724&amp;ssl=1 724w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/wall-thickening.jpg?resize=300%2C210&amp;ssl=1 300w\" sizes=\"auto, (max-width: 525px) 100vw, 525px\" \/><figcaption id=\"caption-attachment-1852\" class=\"wp-caption-text\">Wall thickening and fat stranding<\/figcaption><\/figure>\n<p>\u00a0<\/p>\n<p>Ultrasound is also helpful in looking for abscess, such as in our case. We see there is an area of hypoechogenicity with no color flow, representing likely abscess adjacent to the bowel. \u00a0<\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-1846\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2020\/10\/divertic-fluid-collection.png?resize=525%2C340&#038;ssl=1\" alt=\"\" width=\"525\" height=\"340\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/divertic-fluid-collection.png?w=791&amp;ssl=1 791w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/divertic-fluid-collection.png?resize=300%2C195&amp;ssl=1 300w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/divertic-fluid-collection.png?resize=768%2C498&amp;ssl=1 768w\" sizes=\"auto, (max-width: 706px) 89vw, (max-width: 767px) 82vw, 740px\" \/><\/p>\n<p>\u00a0<\/p>\n<p>Our patient ultimately got a CT scan that confirmed he had diverticulitis with abscess. He was admitted to medicine with GI and surgery consults following.<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj mpce-prvt-707-5985662dc5e2b motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>References<\/h3><div>\n<p>(1) Lameris, W et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008 Nov;18(11):2498-511.<\/p>\n<p>(2) Schwerk, WB et al. Sonography in acute colonic diverticulitis. A prospective stud. Dis Colon Rectum<span class=\"period\">. <\/span><span class=\"cit\">1992 Nov;35(11):1077-8<\/span><\/p>\n<p>(3) Mazzei M et al. Sigmoid diverticulitis: US findings. Crit Ultrasound J. 2013 Jul 15;5 Suppl 1(Suppl 1):S5.<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<p style=\"text-align: center;\"><span style=\"font-weight: bold;\">This post was written by Charles Murchison MD, with editing from Colleen Campbell MD and Amir Aminlari MD.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"&nbsp; A 56 year old male with a history of uncomplicated diverticulitis presented to the emergency room with left lower quadrant pain and loose stools for the last six days. He denies fever, vomiting or blood in hist stool&nbsp; Vitals: T 97.3 &nbsp; BP 152\/81 &nbsp; HR 91 &nbsp; &nbsp; &nbsp; RR 18&nbsp; &nbsp; &nbsp; &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/10\/28\/diverticulitis-abscess\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Case 24: Diverticulitis\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":1846,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"link","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[18,83,84],"class_list":["post-1841","post","type-post","status-publish","format-link","has-post-thumbnail","hentry","category-clinical-cases","tag-abscess","tag-diverticulitis","tag-gi","post_format-post-format-link"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Case 24: Diverticulitis - UCSD Ultrasound<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/10\/28\/diverticulitis-abscess\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case 24: Diverticulitis - UCSD Ultrasound\" \/>\n<meta property=\"og:description\" content=\"&nbsp; A 56 year old male with a history of uncomplicated diverticulitis presented to the emergency room with left lower quadrant pain and loose stools for the last six days. He denies fever, vomiting or blood in hist stool&nbsp; Vitals: T 97.3 &nbsp; BP 152\/81 &nbsp; HR 91 &nbsp; &nbsp; &nbsp; RR 18&nbsp; &nbsp; &nbsp; &hellip; Continue reading &quot;Case 24: Diverticulitis&quot;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/10\/28\/diverticulitis-abscess\/\" \/>\n<meta property=\"og:site_name\" content=\"UCSD Ultrasound\" \/>\n<meta property=\"article:published_time\" content=\"2020-10-28T08:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-01-18T20:57:14+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2020\/10\/divertic-fluid-collection.png?fit=791%2C513&ssl=1\" \/>\n\t<meta property=\"og:image:width\" content=\"791\" \/>\n\t<meta property=\"og:image:height\" content=\"513\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"UCSD Ultrasound\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:site\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"UCSD Ultrasound\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/\"},\"author\":{\"name\":\"UCSD Ultrasound\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/person\\\/b29066b4104637bc43b8a1c79c2cda34\"},\"headline\":\"Case 24: Diverticulitis\",\"datePublished\":\"2020-10-28T08:00:00+00:00\",\"dateModified\":\"2021-01-18T20:57:14+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/\"},\"wordCount\":431,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/i0.wp.com\\\/emultrasound.ucsd.edu\\\/wp-content\\\/uploads\\\/2020\\\/10\\\/divertic-fluid-collection.png?fit=791%2C513&ssl=1\",\"keywords\":[\"Abscess\",\"diverticulitis\",\"GI\"],\"articleSection\":[\"Clinical Cases\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/\",\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2020\\\/10\\\/28\\\/diverticulitis-abscess\\\/\",\"name\":\"Case 24: Diverticulitis - 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