図１で小さい遊離ガスがある（FA）．主訴が下腹部痛で下腹部に圧痛があるので下腹部の病変を検索するため図１４の直腸1から逆行性に，腸管壁の所見にも注意しながら追跡すると，図１４の2からＳ状結腸で，図５の31から下行結腸となる．図１０と図９のＳ状結腸の壁▲と▲の間は腸管壁の欠損部で，△は腸管外に排出された糞便である．図１０と図１１の↑は腸管外の液貯留とガスでニボーを形成しており，この所見も消化管穿孔を決定づける所見であり，Ｓ状結腸穿孔の診断がつく．憩室を認めず，異物や腫瘍性病変はなく原因疾患はCT上不明である．手術でＳ状結腸の穿孔を認め，Ｓ状結腸部分切除（Hartmann手術）を施行した．病理：perforated sigmoid diverticulum．

文献考察:憩室炎の診断，合併症の診断，治療方針の決定にCTは極めて有用
Ambrosetti P, Becker C, Terrier F.
Colonic diverticulitis: impact of imaging on surgical management -- a prospective study of 542 patients.
Eur Radiol. 2002 May;12(5):1145-9.

The aim of this study was to compare the performance of the CT and the water-soluble contrast enema (CE) in the diagnosis and the severity of acute left-colonic diverticulitis, and to recognize the impact of CT during the acute phase and after a first acute episode successfully treated medically. From 1986 to 1997, all patients admitted in our emergency center with clinically suspected left-colonic diverticulitis had a CE and a CT within 72 h of their admission, unless clinical findings required immediate laparotomy. They were prospectively included in the study if one or both radiological exams showed signs of acute diverticulitis and/or diverticulitis was surgically removed and histologically proven. Diverticulitis was considered moderate when CT showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat and CE showed segmental lumen narrowing and tethered mucosa; it was considered severe when abscess and/or extraluminal air and/or contrast were observed on CT and when one or both of the latter signs were seen on CE. Five hundred forty-two patients entered the study; 465 patients (86%) had a CT exam, 439 (81%) had a CE, and 420 (77%) had both exams. The performance of CT is significantly superior to CE in terms of sensitivity (98 vs 92%, p