E2150. Imaging of Colonic Diverticular Disease: Complications and Mimics
  1. Maria Zulfiqar; Mayo Clinic Arizona
  2. Ari Mehta; Arizona state university
  3. Cameron Adler; Mayo Clinic Arizona
  4. David Ballard; Mallinckrodt Institute of Radiology
  5. Anup Shetty; Mallinckrodt Institute of Radiology
  6. Motoyo Yano; Mayo Clinic Arizona
Diverticulosis and diverticular disease of the colon are increasingly common clinical conditions that are more frequently encountered in elderly patients and in industrialized countries. A significant increase in diverticular disease, particularly acute diverticulitis, has been reported in recent years, along with an increasing rate of hospital admission, morbidity, and mortality. Radiologic evaluation particularly with CT is usually needed for confirmation in the emergent setting and to exclude malignancy and other complications.

Educational Goals / Teaching Points
The educational goals for this exhibit is to illustrate pathophysiology and anatomy of colonic diverticulosis and diverticulitis for basic and advanced understanding for radiology residents, fellows, and attendings. Provide case-based review of the imaging features of various complications of diverticular disease. Case-based review of the imaging features of various acute and chronic complications of diverticulitis. Discuss atypical clinical presentations and mimics of diverticulitis on imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pathophysiology and anatomy: colonic diverticula are typically false in nature with missing the muscularis layer and overall, very thin-walled; increased risk for perforation when they get obstructed and inflamed compared to normal colon. Complications of diverticular disease: bleeding; diverticulitis. Acute complications of diverticulitis: perforation (contained and frank); abscess (intramural, pericolonic and distant); thrombophlebitis. Chronic complications of diverticulitis: colonic stricture; adhesions and small bowel obstruction; fistulizing disease; chronic smoldering diverticulitis. Atypical complications: secondary appendicitis; distal ureteric obstruction; septic pubic symphysitis; discitis/osteomyelitis. Mimics: segmental colitis associated with diverticulosis (SCAD); colon cancer; colonic endometriosis.

A wide array of imaging appearances can occur related to complications of colonic diverticular disease. Timely diagnosis with imaging, particularly CT is crucial to prevent considerable patient morbidity and mortality.