diverticulitis 22/07/02

CASE1 >

F/39

응급실 기록

내원 당일 오후 6시 부터 시작된 flank pain을 주소로 본원 응급실 내원함.

RLQ pain 동반되며 속이 메스꺼워 어제부터 식사를 잘 하지 못했다고 함.

BT 38.2

P/Ex RLQ Td (+) N/V (-/-) Urinary symptom - c/s/r -/-/-

 

응급실 검사 

CRP (C-Reactive Protein), quan.  77.81            ▲

WBC Count                    11.29            ▲

APCT > 

Adm 기록 GS 

입원하여 conservative care

게실에 대한 평가 위하여 증상 회복 후 대장내시경 f/u이 필요함을 설명함.

 -> 여러 번 재발시 장 절제 수술

CASE2>

Case review > diverticulitis

diverticulosis : diverticula가 있는것

diverticulitis : 염증이 생긴 것

• Sx : abd pain, Td, fever, leukocytosis / 진행될수록 symp more generalized, widespread

What are the imaging studies to detect findings of diverticulosis?

• Lower GI EGD
• CT

What are the imaging findings of diverticulitis?

• US: Abnormal wall thickening of more than 4 mm involving a segment 5 cm or longer at the point of maximal tenderness.
• CT:
  • Diverticula
  • Narrowed lumen
  • Segmental Thickened bowel wall : usually has inner and outer high-attenuation layers, with a thick middle layer of low attenuation
  • Fascial inflammatory infiltration
  • Complications
    • Perforation: Free air in the peritoneum
    • Abscess

diverticulitis

Perforated Diverticulum

• Arrowheads point to free air.
• Arrows points to collection of fluid around bowel loops.
• Black arrows point to pericolonic fascial infiltration.

Perforated Diverticulum