Question: A 56-year-old man presented for new onset abdominal pain. His past medical history was significant for bilateral inguinal hernia repair and appendectomy in 1997. In 2004, he was evaluated for recurrent hematochezia and a flexible sigmoidoscopy at that time revealed internal hemorrhoids. Three months before this presentation, he began to complain of colicky abdominal pain, localized to the left lower quadrant and suprapubic area. The pain was increased by food intake and was not associated with any other symptoms. The physical examination and laboratory findings were normal. Abdominal and pelvic computed tomography (CT; FigureA) showed, in addition to the extensive sigmoid diverticulosis, mild streaking with possible air-pocket containing collection in continuity with the sigmoid colon and anterior to, and inseparable from, the bladder and anterior pelvic wall (white arrow). These findings were suggestive of sigmoid diverticulitis and the patient was started on oral ciprofloxacin and metronidazole with no pain relief.
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