Gastrointestinal Imaging

Diverticulum, ascending colon and caecum

true diverticulum containing the three layers of the bowel wall: mucosa, submucosa and muscularis mucosa and arising in the caecum or the ascending colon. The acquired type of diverticulum of the ascending colon and the caecum is less common than that of the left colon in the Western world, but not in Japan. It is discussed under diverticular disease, diverticulosis and diverticulitis of the colon. The true diverticula of the ascending colon are mostly solitary and may contain a faecalith. Complications such as inflammation and perforation with peridiverticulitis are not uncommon.

Radiological imaging is important to distinguish this condition from acute appendicitis, which may cause similar clinical symptoms. The inflammatory changes are best visible on CT (Fig.1) as increased attenuation in the mesenteric lipomatous tissue, adjacent to the colon due to strand-like linear structures and/or the presence of extraluminal air. Contrast enemas with water soluble contrast medium can be used to visualize the diverticulum and sometimes the extravasation at the site of the perforation.

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Fig.1

Peridiverticulitis due to perforation of true diverticulum of the ascending colon. CT of the mid-abdomen following peroral contrast medium administration. Presence of air bubbles (arrow) and normally elevated attenuation of mesenteric fat situated medially from the ascending colon. Inflammatory thickening (arrowhead) of parietal peritoneum.
Diverticulum, ascending colon and caecum, Fig.1