Ikhatua EP, Agarwal S and Kumar G
Acute diverticulitis is considered to be due to perforation of a diverticulum. Abdominal pain is the most common complaint. Patients may have localized peritoneal signs or generalized peritonitis resulting from rupture of a diverticular abscess. Differentials include cystitis, nephrolithiasis, IBS, acute appendicitis, infectious colitis, ischemic colitis, colorectal cancer and gynaecological conditions. We report an unusual presentation of a pelvic mass which was thought to be of ovarian origin, prompting a referral to gynaecology. She was referred from primary care to gynaecology as suspected ovarian malignancy. She presented with history of left lower abdominal pain, diarrhoea, vomiting, loss of appetite and feeling unwell. There was a firm, immobile mass in the left lower abdomen. CT abdomen+pelvis showed a large multi-locular abscess measuring 11.6 cm × 7.3 cm × 8.0 cm, probably arising from perforated sigmoid colon with diverticular disease. Percutaneous drainage of the abscess was performed. She also had a course of antibiotics. She was discharged 3 days after the intervention. Complicated diverticulitis manifests as bowel obstruction, abscess, fistula, or perforation. Gynaecological differentials include tubo-ovarian abscess, ovarian cyst accident, ectopic pregnancy.
