Abdominal Pain with Elevated β-hCG: MRI Diagnosis of Acute Descending Colonic Diverticulitis
A 30-Year-Old Woman with Abdominal Pain: Why MRI Can Be an Important Imaging Option
When a young woman presents with acute abdominal pain, selecting the appropriate imaging examination requires more than simply asking which modality provides the highest diagnostic accuracy.
The clinical context matters.
When serum β-human chorionic gonadotropin (β-hCG) is elevated, pregnancy or early pregnancy-related conditions must be considered. At the same time, the radiologist must evaluate a broad range of gastrointestinal, genitourinary, and gynecologic disorders that may produce overlapping symptoms.
This case illustrates the diagnostic value of MRI in a woman in her 30s who presented with right upper abdominal and left-sided abdominal pain radiating toward the lower back. Her serum β-hCG level was elevated, and she had a history of laparoscopic cholecystectomy.
MRI demonstrated focal circumferential wall thickening involving the mid descending colon, accompanied by increased T2 signal and adjacent inflammatory changes. Colonic diverticulosis was also present in the affected region. Taken together, these findings were compatible with acute descending colonic diverticulitis.
The importance of this case is not simply that diverticulitis can be detected on MRI.
The more important lesson is how clinical context, imaging selection, anatomical localization, inflammatory pattern recognition, and assessment of complications must be integrated into a single diagnostic process.
Key Imaging Findings
The MRI findings in this case can be summarized by four major components:
Focal circumferential wall thickening of the descending colon
Increased T2 signal associated with inflammatory edema
Adjacent pericolic inflammatory change
Diverticulosis in the involved colonic segment
The spatial relationship among these findings is critical.
A diverticulum alone indicates diverticulosis, not necessarily diverticulitis. The diagnosis becomes much stronger when a specific diverticulum is associated with focal bowel-wall inflammation and surrounding inflammatory change.
Figure 1. Axial T2 Fat-Suppressed MRI
Figure 1. Axial T2 fat-suppressed MRI demonstrating acute descending-colon diverticulitis.
Radiology Interpretation:
Focal circumferential wall thickening is present in the mid descending colon, with increased T2 signal and adjacent inflammatory changes. The findings are compatible with a focal inflammatory process involving the descending colon. In the appropriate clinical context, the combination of diverticulosis and adjacent inflammation supports acute diverticulitis.
Clinical Significance:
MRI evaluation should not rely exclusively on bowel-wall thickness. The radiologist should evaluate the bowel wall, adjacent soft tissues, diverticula, and potential complications as an integrated pattern.
Why Coronal MRI Matters
Axial imaging is particularly useful for evaluating focal bowel-wall thickening and the relationship between the bowel and surrounding inflammatory tissue.
Coronal imaging provides complementary information.
It helps demonstrate the longitudinal extent of the inflammatory process and its relationship to adjacent abdominal structures.
Figure 2. Coronal T2-Weighted MRI
Figure 2. Coronal T2-weighted MRI demonstrating colonic diverticulosis and focal inflammatory change.
Radiology Interpretation:
Coronal T2-weighted imaging demonstrates colonic diverticulosis with focal wall thickening and inflammatory changes involving the mid descending colon. No definite drainable abscess is described in the source case material.
Medical Insight:
Multiplanar imaging is important because diverticulitis is a three-dimensional inflammatory process. The diagnosis should not depend on a single axial image.
Diverticulosis Is Not the Same as Diverticulitis
One of the most important concepts in interpreting colonic imaging is the distinction between diverticulosis and diverticulitis.
Diverticulosis refers to the presence of diverticula.
Diverticulitis refers to inflammation associated with a diverticulum.
Therefore, the presence of multiple diverticula does not establish acute diverticulitis.
The radiologist should determine whether the symptomatic inflammatory process is anatomically centered on a diverticulum.
In this case, diverticulosis was associated with focal bowel-wall thickening and adjacent inflammatory changes involving the descending colon. This combination provides the imaging basis for the diagnosis of acute descending colonic diverticulitis.
Pathophysiology of Acute Diverticulitis
The pathophysiology of diverticulitis is more complex than a simple bacterial infection of a diverticulum.
Traditional concepts emphasized obstruction of a diverticular neck, increased intraluminal pressure, mucosal injury, localized ischemia, and subsequent inflammation or microperforation.
Current understanding recognizes a multifactorial process involving bowel-wall structure, intestinal microbiota, low-grade inflammation, motility, and neuromuscular factors.
From an imaging perspective, these processes ultimately manifest as localized bowel-wall abnormalities, surrounding inflammatory changes, and, in more severe cases, perforation or abscess formation.
Can Diverticulitis Occur in Younger Adults?
Yes.
Although diverticular disease has historically been associated with older adults, acute colonic diverticulitis also occurs in younger and middle-aged patients.
The increasing recognition of diverticulitis among younger adults means that age alone should not be used to exclude the diagnosis.
A young patient with persistent abdominal pain, localized tenderness, inflammatory findings, or compatible imaging findings may still have acute diverticulitis.
Abdominal Pain Does Not Always Follow the Classic Pattern
The classic presentation of left-sided diverticulitis is left lower quadrant abdominal pain.
However, the location of pain can vary.
Anatomical variation, the position of the colon, and the extent of inflammation may alter the clinical presentation.
In this case, the patient experienced right upper abdominal and left-sided abdominal pain with radiation toward the lower back. Such a presentation requires a broad differential diagnosis rather than assuming diverticulitis from the beginning.
Important differential diagnoses include:
| Differential Diagnosis | Important Considerations |
|---|---|
| Ureteral stone | Urinary tract findings and calculus |
| Pyelonephritis | Renal and urinary inflammatory changes |
| Acute appendicitis | Appendix and periappendiceal inflammation |
| Ovarian disease | Adnexal abnormalities |
| Ectopic pregnancy | β-hCG elevation with abdominal pain |
| Pelvic inflammatory disease | Pelvic inflammatory findings |
| Crohn disease | Segmental or multifocal bowel inflammation |
| Colorectal cancer | Irregular or asymmetric bowel-wall thickening |
| Bowel obstruction | Dilated bowel and transition point |
| Other acute abdominal disorders | Clinical and imaging correlation |
The elevated β-hCG level is particularly important.
Abdominal pain combined with elevated β-hCG requires consideration of pregnancy-related conditions, including ectopic pregnancy, even when an alternative gastrointestinal abnormality is identified.
Why MRI Can Be Considered When β-hCG Is Elevated
CT is a highly effective imaging modality for diagnosing acute diverticulitis and detecting complications.
However, when pregnancy is possible, radiation exposure becomes an important consideration.
MRI does not use ionizing radiation and therefore may provide an important alternative when clinically appropriate.
In this case, MRI successfully demonstrated the inflammatory abnormality involving the descending colon.
This does not mean that CT should automatically be avoided whenever β-hCG is elevated.
If CT is clinically necessary, the potential diagnostic benefit must be weighed against radiation exposure.
The correct principle is therefore not:
“CT must never be performed during possible pregnancy.”
Instead:
“The imaging strategy should be individualized according to the clinical situation, diagnostic urgency, and potential risks.”
CT Evaluation: Look Beyond the Diagnosis
When CT is performed for suspected acute diverticulitis, the examination should not stop after identifying bowel-wall thickening.
The radiologist should systematically evaluate for complications.
| CT Finding | Clinical Significance |
|---|---|
| Bowel-wall thickening | Local inflammatory change |
| Diverticula | Structural basis of diverticular disease |
| Pericolic fat stranding | Surrounding inflammation |
| Extraluminal gas | Possible microperforation or perforation |
| Abscess | Complicated diverticulitis |
| Free intraperitoneal air | Possible perforation |
| Free fluid | Inflammatory or peritoneal involvement |
| Fistula | Complicated or chronic disease |
| Bowel obstruction | Complication |
| Diffuse peritonitis | Severe disease |
The value of CT is therefore not simply its ability to identify diverticulitis.
Its major clinical value also lies in identifying findings that can change management.
Four MRI Findings to Analyze in Diverticulitis
1. Focal Bowel-Wall Thickening
Inflammation commonly produces localized thickening of the affected bowel wall.
2. Increased T2 Signal
T2-weighted and fat-suppressed T2-weighted sequences can demonstrate inflammatory edema.
3. Pericolic Inflammatory Change
Changes in the tissues surrounding the bowel support an active inflammatory process.
4. Extraluminal Complications
Abscess, perforation, fistula, and peritonitis should be actively assessed.
The diagnostic pattern in this case can therefore be summarized as:
Bowel-wall thickening + T2 signal increase + pericolic inflammatory change + diverticulosis
This combination provides the central MRI pattern supporting acute descending colonic diverticulitis.
Practical Radiology Approach
A systematic interpretation strategy can reduce diagnostic errors.
Step 1: Localize the abnormal bowel segment
Determine which portion of the colon is involved.
In this case, the abnormality involves the descending colon.
Step 2: Evaluate bowel-wall morphology
Look for focal or diffuse wall thickening and determine whether it is symmetric or asymmetric.
Step 3: Identify diverticula
Look for diverticula adjacent to the inflammatory focus.
Step 4: Evaluate surrounding tissues
Assess for pericolic inflammatory change.
Step 5: Search for extraluminal gas
Extraluminal gas may indicate microperforation or perforation.
Step 6: Search for abscess
Determine whether a drainable collection is present.
Step 7: Assess for fistula or obstruction
These findings may indicate complicated disease.
Step 8: Assess the peritoneal cavity
Look for free air, free fluid, and diffuse peritoneal inflammatory changes.
This sequence can be summarized as:
Differential Diagnosis: Inflammatory Bowel Disease
Crohn disease and other inflammatory bowel disorders can produce bowel-wall thickening and surrounding inflammatory changes.
However, diverticulitis is typically characterized by focal inflammation centered on a diverticulum.
Crohn disease may demonstrate longer segments of bowel involvement, skip lesions, fistulas, or other characteristic manifestations.
Therefore, bowel-wall thickening alone should never be considered diagnostic of diverticulitis.
Differential Diagnosis: Colorectal Cancer
Colorectal cancer can also produce bowel-wall thickening and surrounding tissue abnormalities.
Features that may increase concern for malignancy include:
Markedly irregular wall thickening
Asymmetric wall thickening
Mass formation
Significant luminal narrowing
Abnormal lymph nodes
Persistent or progressive abnormalities
Because colorectal cancer and diverticulitis can overlap in appearance, clinical history and follow-up evaluation may be necessary.
Differential Diagnosis: Gynecologic Emergencies
This case also emphasizes the importance of gynecologic differential diagnosis.
An elevated β-hCG level combined with abdominal pain requires consideration of ectopic pregnancy and other pregnancy-related emergencies.
Finding diverticulitis on imaging should not automatically explain every symptom.
The radiologist must always ask:
Does the imaging diagnosis adequately explain the entire clinical presentation?
This question is fundamental to safe diagnostic imaging.
Hinchey Classification and Disease Severity
The Hinchey classification has traditionally been used to describe the severity of acute diverticulitis.
| Stage | Major Feature |
|---|---|
| Stage I | Pericolic inflammation or localized abscess |
| Stage II | Pelvic or distant abscess |
| Stage III | Generalized purulent peritonitis |
| Stage IV | Generalized fecal peritonitis |
However, assigning a stage is not a substitute for describing the actual imaging findings.
A clinically useful report should clearly state whether there is:
Abscess
Extraluminal gas
Free intraperitoneal air
Perforation
Fistula
Bowel obstruction
Diffuse peritonitis
The source case material mentions Hinchey Ib, while the described MRI findings do not clearly document a definite drainable abscess. Therefore, the actual imaging should be reviewed before assigning a final Hinchey stage.
This distinction is important because disease classification should follow the imaging findings rather than the other way around.
Treatment: Does Every Patient Need Antibiotics or Surgery?
No.
Treatment depends on disease severity, complications, systemic inflammatory response, immune status, and the overall clinical condition of the patient.
In selected patients with uncomplicated diverticulitis, routine antibiotic treatment is not necessarily required in every case.
However, this should not be interpreted as:
“Antibiotics are never necessary for diverticulitis.”
Patients with severe systemic inflammation, immunosuppression, or complicated disease may require a different treatment strategy.
The central clinical distinction is:
Uncomplicated diverticulitis vs. complicated diverticulitis.
Why Abscess Changes Management
An abscess is one of the most important imaging findings distinguishing complicated from uncomplicated diverticulitis.
Management may depend on abscess size, anatomical location, accessibility, and the patient's clinical condition.
When an abscess is identified, the radiologist should provide more than a simple statement that an abscess is present.
The report should describe its:
Location
Size
Relationship to the bowel
Relationship to adjacent organs
Potential accessibility for drainage
This information can directly assist clinical management.
When Is Surgery Considered?
Perforated diverticulitis with generalized peritonitis represents severe disease.
Patients with generalized purulent or fecal peritonitis may require urgent surgical management depending on the clinical situation.
This is why the radiology report should not end with:
“Acute diverticulitis.”
A clinically useful report should communicate whether there is:
abscess, extraluminal gas, perforation, obstruction, fistula, or diffuse peritonitis.
The role of the radiologist extends beyond naming the disease. It includes communicating findings that may alter treatment.
CT and MRI Are Complementary, Not Competing Modalities
CT and MRI should not be viewed as competitors.
CT is fast, widely available, and highly effective for acute abdominal emergencies and complication assessment.
MRI avoids ionizing radiation and can provide excellent soft-tissue and bowel-wall characterization.
| Feature | CT | MRI |
|---|---|---|
| Examination speed | Very fast | Relatively slower |
| Ionizing radiation | Yes | No |
| Acute emergency imaging | Excellent | Useful in selected situations |
| Bowel-wall assessment | Excellent | Excellent |
| Pericolic inflammation | Excellent | Useful |
| Perforation assessment | Excellent | Possible |
| Abscess assessment | Excellent | Excellent |
| Pregnancy considerations | Radiation must be considered | Important alternative |
| Emergency availability | Generally high | More limited |
The optimal modality depends on the patient and the clinical question.
Acute Diverticulitis Imaging Algorithm
Example Radiology Report
A concise radiology report for the described case could be structured as follows:
Findings
Focal circumferential wall thickening of the mid descending colon with adjacent inflammatory edema and soft-tissue inflammatory change.
Associated colonic diverticulosis.
Impression
Focal circumferential wall thickening of the mid descending colon with adjacent inflammatory changes.
Associated colonic diverticulosis.
Findings are compatible with acute descending colonic diverticulitis.
No definite drainable abscess is identified based on the described MRI findings.
No definite imaging evidence of diffuse peritonitis is described.
If extraluminal gas, abscess, perforation, or another complication is demonstrated on the actual images, the final report should be modified accordingly.
Ten Expert Insights
Expert Insight 1 — Radiologist Perspective
The diagnosis of diverticulitis is not simply about finding diverticula. It is about identifying the center of inflammation and determining whether it corresponds anatomically to a diverticulum.
Expert Insight 2 — Clinical Perspective
Atypical pain location does not exclude diverticulitis.
Expert Insight 3 — Pregnancy-Safety Perspective
An elevated β-hCG level can influence the imaging strategy in a young woman with acute abdominal pain.
Expert Insight 4 — MRI Perspective
MRI interpretation should integrate bowel-wall thickening, T2 signal abnormalities, and surrounding inflammatory changes.
Expert Insight 5 — CT Perspective
The major clinical value of CT extends beyond diagnosis to detection of complications.
Expert Insight 6 — Emergency Perspective
Extraluminal gas, abscess, perforation, obstruction, fistula, and diffuse peritonitis are critical findings.
Expert Insight 7 — Differential Diagnosis Perspective
Elevated β-hCG with abdominal pain requires consideration of gynecologic emergencies, including ectopic pregnancy.
Expert Insight 8 — Reporting Perspective
A report stating only “acute diverticulitis” may be insufficient. Complications should be explicitly addressed.
Expert Insight 9 — Severity Perspective
Disease classification should reflect the actual imaging findings.
Expert Insight 10 — Patient-Centered Imaging Perspective
The most accurate examination and the most appropriate examination are not always the same.
Clinical Pearls
Diverticulosis and diverticulitis are not synonymous.
Bowel-wall thickening alone is not sufficient to diagnose diverticulitis.
The relationship between a diverticulum and adjacent inflammation is critical.
T2 fat-suppressed MRI can demonstrate inflammatory edema.
Coronal imaging helps evaluate longitudinal disease extent.
CT should be systematically assessed for extraluminal gas.
Abscess detection can alter treatment strategy.
Free air and diffuse peritonitis may indicate severe perforated disease.
Elevated β-hCG with abdominal pain requires consideration of ectopic pregnancy.
MRI is not universally superior to CT.
Imaging strategy should consider pregnancy and radiation exposure when relevant.
Treatment begins with distinguishing uncomplicated from complicated diverticulitis.
Antibiotics are not automatically required for every uncomplicated case.
Generalized peritonitis associated with perforation may require surgical management.
Radiology reporting should provide clinically actionable information.
Common Diagnostic Pitfalls
Pitfall 1. Diagnosing Diverticulitis Simply Because Diverticula Are Present
Diverticulosis may be incidental. The inflammatory abnormality must correspond anatomically to the involved diverticulum.
Pitfall 2. Relying Only on Bowel-Wall Thickening
Colorectal cancer and inflammatory bowel disease can also cause bowel-wall thickening.
Pitfall 3. Excluding Diverticulitis Because the Pain Is Not in the Left Lower Quadrant
Clinical symptoms can vary according to anatomy and the extent of inflammation.
Pitfall 4. Ignoring Elevated β-hCG
Pregnancy-related emergencies must remain within the differential diagnosis.
Pitfall 5. Failing to Evaluate Complications
Abscess, perforation, extraluminal gas, fistula, obstruction, and peritonitis can fundamentally change management.
Pitfall 6. Assigning a Hinchey Stage Without Reviewing the Actual Images
Disease classification should follow the demonstrated imaging findings.
Pitfall 7. Treating CT and MRI as a Simple Competition
Each modality has different strengths and limitations.
Pitfall 8. Assuming Every Case Requires Surgery
Management depends on disease complexity, complications, and the patient's clinical status.
Frequently Asked Questions
What is acute diverticulitis?
Acute diverticulitis is an inflammatory condition centered on a colonic diverticulum. Imaging commonly demonstrates focal bowel-wall thickening and surrounding inflammatory change, particularly when these findings are anatomically associated with diverticulosis.
Can MRI diagnose acute diverticulitis?
Yes. MRI can demonstrate bowel-wall thickening, inflammatory edema, and surrounding inflammatory changes. It can be particularly useful when avoiding ionizing radiation is desirable.
Does elevated β-hCG mean CT cannot be performed?
No. Elevated β-hCG may indicate pregnancy and therefore requires consideration of radiation exposure. However, CT may still be appropriate when clinically necessary. The decision should balance diagnostic urgency and potential risks.
Why is CT important in diverticulitis?
CT provides rapid and highly accurate assessment of diverticulitis and is particularly valuable for detecting complications such as perforation, extraluminal gas, abscess, fistula, obstruction, and peritonitis.
What is the difference between diverticulosis and diverticulitis?
Diverticulosis refers to the presence of diverticula. Diverticulitis refers to inflammation associated with a diverticulum.
Why is an abscess important?
An abscess indicates complicated disease and may influence treatment, including consideration of image-guided drainage depending on its size, location, and the patient's clinical condition.
Does diverticulitis always require surgery?
No. Many patients with uncomplicated disease can be managed without surgery. Severe complications such as generalized peritonitis may require surgical treatment.
Can young adults develop diverticulitis?
Yes. Diverticulitis can occur in younger adults, and age alone should not be used to exclude the diagnosis.
What are the most important MRI findings?
The key findings include focal bowel-wall thickening, increased T2 signal, surrounding inflammatory changes, and diverticula centered on the inflammatory focus.
What should a radiologist look for on CT?
The radiologist should systematically assess the bowel wall, diverticula, pericolic inflammation, extraluminal gas, abscess, free air, fistula, obstruction, and peritonitis.
Clinical Reasoning Quiz
1. A woman in her 30s presents with abdominal pain and elevated β-hCG. MRI demonstrates focal circumferential wall thickening of the mid descending colon, adjacent inflammatory changes, and diverticulosis. What is the most likely diagnosis?
① Ascending colonic diverticulitis
② Transverse colonic diverticulitis
③ Acute descending colonic diverticulitis
④ Crohn disease
⑤ Colorectal cancer
Correct Answer: ③ Acute descending colonic diverticulitis
Explanation: The lesion is centered in the mid descending colon and demonstrates focal wall thickening, adjacent inflammation, and associated diverticulosis. This combination is compatible with acute descending colonic diverticulitis.
① CT is absolutely contraindicated.
② MRI does not use ionizing radiation and may be an alternative.
③ Plain radiography is sufficient to confirm diverticulitis.
④ MRI cannot evaluate bowel-wall thickening.
⑤ Ultrasound has no role in abdominal inflammatory disease.
Correct Answer: ② MRI does not use ionizing radiation and may be an alternative.
Explanation: MRI does not use ionizing radiation and can demonstrate bowel-wall and inflammatory abnormalities. However, CT should not automatically be excluded when it is clinically necessary.
① Uncomplicated diverticulitis
② Incidental free air
③ Mild disease suitable for observation alone
④ Severe perforated diverticulitis requiring urgent clinical and surgical evaluation
⑤ Colorectal cancer requiring chemotherapy
Correct Answer: ④ Severe perforated diverticulitis requiring urgent clinical and surgical evaluation
Explanation: Free intraperitoneal air and generalized peritonitis are important indicators of severe perforated diverticulitis and may require urgent surgical management.
The Deeper Lesson From This Case
The most important lesson from this case is not simply that MRI can demonstrate diverticulitis.
The deeper lesson is that imaging decisions should be integrated with the patient's clinical context.
A young woman with abdominal pain and elevated β-hCG presents a different imaging problem from an older patient with classic left lower quadrant pain.
The imaging strategy must consider pregnancy, radiation exposure, diagnostic urgency, and alternative diagnoses.
Once MRI is selected, interpretation should proceed systematically.
The radiologist should identify:
focal bowel-wall thickening
T2 signal abnormality
pericolic inflammatory change
associated diverticulosis
and then actively search for:
abscess
extraluminal gas
perforation
fistula
obstruction
peritonitis
This approach transforms imaging from simple disease detection into clinically meaningful decision support.
Conclusion
Acute colonic diverticulitis is common, but its imaging interpretation requires careful clinical reasoning.
In a young woman with abdominal pain and elevated β-hCG, the selection of an imaging modality requires particular attention to the clinical context and potential radiation exposure.
MRI can provide valuable information without ionizing radiation and can demonstrate focal bowel-wall thickening, increased T2 signal, and surrounding inflammatory changes.
In this case, the combination of focal circumferential thickening of the mid descending colon, adjacent inflammatory change, and diverticulosis supports the diagnosis of acute descending colonic diverticulitis.
However, the diagnosis should not end with the words “acute diverticulitis.”
The radiologist should determine whether there is:
abscess, extraluminal gas, perforation, fistula, obstruction, free air, or diffuse peritonitis.
These findings determine the clinical severity and may directly influence treatment.
The essential imaging principle can be summarized in one sentence:
Localize the bowel abnormality, identify the diverticulum, characterize the inflammation, and then search systematically for complications.
For women with abdominal pain and elevated β-hCG, one additional question should always remain in the diagnostic process:
Can the gastrointestinal imaging finding explain the patient's entire clinical presentation?
That question represents the difference between simply recognizing an abnormality and practicing clinically meaningful diagnostic imaging.
Key Takeaways
Diverticulosis and diverticulitis are distinct entities.
Focal bowel-wall thickening alone does not establish diverticulitis.
The anatomical relationship between diverticula and surrounding inflammation is critical.
T2 fat-suppressed MRI can demonstrate inflammatory edema.
Coronal MRI provides useful information about the longitudinal extent of disease.
CT remains highly valuable for acute diverticulitis and complication assessment.
Extraluminal gas, abscess, perforation, fistula, obstruction, and peritonitis must be actively evaluated.
Elevated β-hCG with abdominal pain requires consideration of pregnancy-related emergencies.
MRI may be an important alternative when avoiding ionizing radiation is clinically desirable.
CT and MRI should be considered complementary rather than competing modalities.
Treatment depends on whether the disease is uncomplicated or complicated.
Imaging findings should be communicated in a way that supports clinical decision-making.
References
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[3] O. Buckley, T. Geoghegan, G. McAuley, T. Persaud, F. Khosa, and W. C. Torreggiani, “Pictorial review: Magnetic resonance imaging of colonic diverticulitis,” European Radiology, vol. 17, no. 1, pp. 221–227, 2007, doi: 10.1007/s00330-006-0236-z.
[4] G. Liljegren, A. Chabok, M. Wickbom, K. Smedh, and K. Nilsson, “Acute colonic diverticulitis: A systematic review of diagnostic accuracy,” Colorectal Disease, vol. 9, no. 6, pp. 480–488, 2007, doi: 10.1111/j.1463-1318.2007.01238.x.
[5] M. Barat, A. Dohan, K. Pautrat, M. Boudiaf, R. Dautry, Y. Guerrache, M. Pocard, C. Hoeffel, C. Eveno, and P. Soyer, “Acute colonic diverticulitis: An update on clinical classification and management with MDCT correlation,” Abdominal Radiology, vol. 41, no. 9, pp. 1842–1850, 2016, doi: 10.1007/s00261-016-0764-1.
[6] M. Sartelli et al., “2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting,” World Journal of Emergency Surgery, vol. 15, no. 1, Art. no. 32, 2020, doi: 10.1186/s13017-020-00313-4.
[7] J. K. Schultz et al., “European Society of Coloproctology: Guidelines for the management of diverticular disease of the colon,” Colorectal Disease, vol. 22, suppl. 2, pp. 5–28, 2020, doi: 10.1111/codi.15140.
Medical Disclaimer
This article is intended for medical education and professional discussion of diagnostic imaging. It does not replace individualized medical evaluation or treatment. Patients with acute abdominal pain, elevated β-hCG, possible pregnancy, or suspected diverticulitis should receive appropriate assessment by qualified healthcare professionals.
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