Clinical Presentation

An 83-year-old woman presents with fever after a long history of intermittent abdominal cramping and distension.

Barium enema shows a narrowed segment of sigmoid colon (large arrow) associated with mass effect along the superior margin and a subtle focus of barium extending toward a small extraluminal gas collection (arrowhead). Multiple sigmoid diverticula (small arrows) are present, and the transverse folds of the sigmoid colon are thickened, consistent with circular muscle hypertrophy.

Differential Diagnosis

• Diverticulitis: This is the most likely explanation for segmental sigmoid narrowing, sigmoid diverticula, and extrinsic mass effect associated with pericolonic gas (abscess). Diverticular disease without frank diverticulitis would be a consideration for thickened transverse folds in the absence of clinical signs of infection.

• Colon adenocarcinoma: