KEY FACTS
Terminology
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Diverticulum: Focal sac-like outpouching off colon
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Diverticulosis: Presence of uncomplicated diverticula
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Diverticulitis: Inflammation of colonic diverticulum
Imaging
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Diverticulosis with adjacent inflamed echogenic pericolic fat ± gas in diverticulum
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Localized tenderness at site of inflamed pericolic fat
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Thickened bowel wall
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Hyperemia on color Doppler assessment
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Complications: Abscess, fistula, stricture, obstruction, perforation with purulent or fecal peritonitis
Top Differential Diagnoses
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Colon cancer
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Colitis
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Acute appendicitis
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Epiploic appendagitis and segmental omental infarction
Pathology
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Due to localized microperforation of inflamed colonic diverticulum secondary to impacted fecalith
Clinical Issues
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Prevalent in Western society, low dietary fiber intake
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Diverticulosis increases with age; < 5% before 40 years to > 65% by 80 years
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Most common in sigmoid and left colon; right-sided diverticulum is more common in young adults
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Acute lower abdominal pain, local tenderness, fever, diarrhea, and rectal bleeding
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Majority settle with conservative management
Diagnostic Checklist
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Consider diverticulitis in differential diagnosis of acute abdomen presenting with lower abdominal pain
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Look for complications, and beware of mimics, e.g., colon carcinoma
Scanning Tips
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Optimally evaluated with combination of linear, curved, and endoluminal transducers
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Scan over area of tenderness, look for complications
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CT or MR for complications
containing multiple diverticula. Localized fat stranding 
and pericolic abscess 
can also be seen.
is shown. The bowel wall is absent at the site of the perforated diverticulum 
. The pericolic fat 
is inflamed.
