Summary

Table 15-1 summarizes the basic features that enable identification of the specific haustral rows and the most

Fig. 15-67. Diverticular involvement by Crohn's disease.

Noncaseating granulomas (arrows) involve the mucosa of two sigmoid diverticula. (Original magnification, X 8.) (Reproduced from Meyers et al.46)

Fig. 15-67. Diverticular involvement by Crohn's disease.

Noncaseating granulomas (arrows) involve the mucosa of two sigmoid diverticula. (Original magnification, X 8.) (Reproduced from Meyers et al.46)

Fig. 15—68. Diverticular involvement by Crohn's disease.

Dissecting intramural tract (arrows) extends from ulcerated diverticulum (D). (Original magnification, X18.) (Reproduced from Meyers et al.46)

Colite Granulomatosa

Fig. 15—69. Granulomatous colitis with ulcerated diverticulosis.

Aphthous ulcerations are present within two diverticula (arrows) adjacent to a localized area of colonic mural induration containing minute mucosal ulcerations. (Reproduced from Meyer et al.46)

Sigmoid Diverticulosis

Fig. 15—70. Diverticulitis complicating granulomatous colitis.

(a) Crohn's disease is evident by the indentation and ulceration on the left side of the rectum and the gross changes in the proximal sigmoid colon (arrows). Multiple diverticula are present.

(b) Enlargement ofboxed area shows 8X1 mm sinus tract penetrating from a sigmoid diverticulum (D). (Reproduced from Meyers et al.46)

Fig. 15—70. Diverticulitis complicating granulomatous colitis.

(a) Crohn's disease is evident by the indentation and ulceration on the left side of the rectum and the gross changes in the proximal sigmoid colon (arrows). Multiple diverticula are present.

(b) Enlargement ofboxed area shows 8X1 mm sinus tract penetrating from a sigmoid diverticulum (D). (Reproduced from Meyers et al.46)

Fig. 15-71. Diverticulitis complicating granulomatous colitis.

A 4.5-cm sinus tract (bracket) in the paracolic tissues communicates with five sigmoid diver-ticula (asterisks). The surrounding abscess produces a mild mass impression on the colon. Proximally, granulomatous colitis is shown by a narrowed lumen and a grossly distorted mucosa with multiple ulcerations (GC). (Reproduced from Meyers et al. )

Fig. 15-71. Diverticulitis complicating granulomatous colitis.

A 4.5-cm sinus tract (bracket) in the paracolic tissues communicates with five sigmoid diver-ticula (asterisks). The surrounding abscess produces a mild mass impression on the colon. Proximally, granulomatous colitis is shown by a narrowed lumen and a grossly distorted mucosa with multiple ulcerations (GC). (Reproduced from Meyers et al. )

Fig. 15—72. Granulomatous colitis with extraluminal longitudinal sinus tract.

An extremely long continuous tract follows the mesenteric border of the sigmoid, descending, and transverse colon. It can be presumed that this striking paracolic localization is due to the communicating form of peridiverticulitis as a consequence of involvement by Crohn's disease.

(Reproduced from Marshak et al.43)

Fig. 15—72. Granulomatous colitis with extraluminal longitudinal sinus tract.

An extremely long continuous tract follows the mesenteric border of the sigmoid, descending, and transverse colon. It can be presumed that this striking paracolic localization is due to the communicating form of peridiverticulitis as a consequence of involvement by Crohn's disease.

(Reproduced from Marshak et al.43)

Crohn Pathogenesis

Fig. 15-73. Pathogenesis of diverticulitis complicating granulomatous colitis.

An aphthous ulcer involving the mucosal lining of a diverticulum (1) may lead to perforation, with the formation of a peridiverticular abscess (2). This may then extend as a longitudinal paracolic sinus tract (3). A fissuring ulcer of granulomatous colitis may directly perforate into a diverticulum (4). Complete transmural fissuring (5) may result in an abscess, deep to the muscularis propria, which may take the form of a longitudinal sinus tract (6). Perforation of the domes of diverticula with peridiverticulitis may occur secondary to extension from either granulomatous colitis (7) or dissecting diverticulitis (8). (Reproduced from Meyers et al.46)

Fig. 15-73. Pathogenesis of diverticulitis complicating granulomatous colitis.

An aphthous ulcer involving the mucosal lining of a diverticulum (1) may lead to perforation, with the formation of a peridiverticular abscess (2). This may then extend as a longitudinal paracolic sinus tract (3). A fissuring ulcer of granulomatous colitis may directly perforate into a diverticulum (4). Complete transmural fissuring (5) may result in an abscess, deep to the muscularis propria, which may take the form of a longitudinal sinus tract (6). Perforation of the domes of diverticula with peridiverticulitis may occur secondary to extension from either granulomatous colitis (7) or dissecting diverticulitis (8). (Reproduced from Meyers et al.46)

Table 15-1 Haustra Anatomy and Pathology

Ascending and descending colon Transverse colon

Table 15-1 Haustra Anatomy and Pathology

Position

Posterior

Lateral

Medial

Superior

Inferior

Posterior

Major relation

Extraperitoneal

Lateral paracolic

Medial paracolic

Gastrocolic ligament

Greater omentum,

Transverse meso

ship

structures

sulcus

sulcus

(stomach, lesser

anterior abdomi

colon (pancreas)

sac)

nal wall

Outlining on

double-contrast

studies

Supine

Barium

Air

Air

Air

Air

Barium

Prone

Air

Barium

Barium

Barium

Barium

Air

Gross designation

Antimesenteric

Mesenteric

Mesenteric border

Antimesenteric

border

border

border

Localized or pre

Primary extraper

Exudate, malignant

Extension from

Extension of gastric

Extension of pancre

Extension of pancre

dominant in

itoneal lesions

seeding in lateral

primary small

carcinoma

atic carcinoma

atic carcinoma

volvement

Diverticulitis

intraperitoneal

bowel process

Primary masses of

and pancreatitis

and pancreatitis

gutter

Diverticulitis

gastrocolic liga

Primary masses of

Primary masses of

Embolic metastases

ment

transverse meso

transverse meso

Never localized di

Enlarged gallbladder

colon

colon

verticulitis; in as

Clioledochal cyst

Scleroderma

Diverticulitis

sociation with in

Diverticulitis

Never localized di

volvement of

verticulitis; in as

other haustral

sociation with in

rows, indicates an

volvement of

extensive para

other h austral

colic abscess

rows, indicates an

extensive para

colic abscess

common conditions resulting in localized involvement. Application of these principles is particularly helpful in the diagnosis of a variety of disease processes at a stage before gross displacement and distortion of the colon result. These concepts allow the precise localization and often the specific diagnosis of an extracolonic lesion at its earliest stage of extension to the large intestine and permit the radiologist to further refine the diagnosis of intraabdominal disease.

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