Purpose: In an Asian population, right colonic diverticulitis is far more common than the left colonic diverticulitis When the hepatic flexure diverticulum inflamed, it can cause right upper quadrant (RUQ) abdominal pain and cannot be differentiated with the acute cholecystitis. As an initial screening diagnostic tool, US is widely used in the evaluation of RUQ pain. It is embarrassing when we met normal gallbladder on US in patients with RUQ pain and Murphy sign positive. The purpose of this study is to present the US findings and clinical significance of hepatic flexure diverticulitis.
Materials & Methods: From October 2001 to Feburary 2006, we diagnosed 5 cases of hepatic flexure diverticulitis on abdominal sonography. All patients performed CT, which revealed hepatic flexure diverticulitis. Follow up colon study in 2 patients and colonoscopy in 3 patients were performed after improvement of diverticulitis, which revealed diverticula in the hepatic flexure. The mean age of the patients were 37 years (29 to 52 years old). They were 3 females and 2 males.
Results: The clinical impression of all patients were acute cholecystitis with RUQ pain and Murphy sign positive on physical examination. The sonographic findings of hepatic flexure diverticulitis were outpouching hypoechoic sac from the hepatic flexure, wallthickening of the hepatic flexure and hyperechoic surrounding peridiverticular fat(100%). All patients had conservative management with successful treatment.
Conclusion: Hepatic flexure diverticulitis is an alternative diagnosis of acute cholecystitis, especially in an Asian population. It has characteristic sonographic findings and can be diagnosed successfully using sonography.