Inflammatory and Infectious Disease of the Colon
Many patients with inflammatory and infectious diseases of the colon present with abdominal pain. CT is now the preferred initial imaging modality for the evaluation of patients who have nonspecific abdominal pain or are suspected of having colonic inflam
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17
Ji Eun Kim and Joon Koo Han
Contents 17.1
Diverticulitis.................................................................................................................................
408
17.2
Appendicitis .................................................................................................................................
410
17.3
Epiploic Appendagitis .................................................................................................................
410
17.4
Ulcerative Colitis .........................................................................................................................
410
17.5
Infectious Colitis..........................................................................................................................
411
17.6
Ischemic Colitis ...........................................................................................................................
412
17.7
Radiation Colitis..........................................................................................................................
412
17.8
Extracolonic Diseases Involving the Colon: Actinomycosis and Endometriosis ...................
412
17.9
Illustrations:·Inflammatory and Infectious Disease of the Colon ...........................................
415
References ..................................................................................................................................................
448
J.E. Kim (*) Department of Radiology, Gyeongsang National University Hospital, Jinju, Republic of Korea e-mail: [email protected] J.K. Han Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea e-mail: [email protected] B.I. Choi (ed.), Radiology Illustrated: Gastrointestinal Tract, Radiology Illustrated, DOI 10.1007/978-3-642-55412-4_17, © Springer-Verlag Berlin Heidelberg 2015
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J.E. Kim and J.K. Han
Abbreviations
17.1
CT CTC CTEg DCBE MDCT MRI SBFS SCBE T1WI T2WI US
Most colonic diverticula are acquired herniations of the mucosa and submucosa (false diverticula) through the muscularis propria at weak points where vasa recta pass through the submucosa. Although the majority of colonic diverticula occur in the distal descending colon and sigmoid colon, they can occur anywhere throughout the colon. However, in Asian populations, right side involvement is more prominent (Almeida et al. 2009). Stasis or obstruction of diverticular neck by inspissated stool or food particles may cause inflammation, bacterial overgrowth, and localized ischemia, ultimately leading to microperforation of the diverticulum and pericolic inflammation which results in acute diverticulitis (Thoeni and Cello 2006). On CT, diverticula appear as small outpouchings of the colonic wall that contain air, contrast material, or fecal material. The involved colonic wall may show circumferential undulating thickening due to the thickening of circular muscle. Typical CT findings of diverticulitis include colonic diverticula with per
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