An unusual case of diverticulitis complicating pregnancy at 33 weeks' gestation

A 38-year-old para 2 presented with the gradual onset of nausea vomiting an d increasing left lower quadrant pain, at 33 weeks' gestation. She was know n to have uterine leiomyomas, with ultrasonography depicting an 8-cm intram ural fundal leiomyoma. In addition a left lateral nondiscrete 10 X 8-cm mas s was depicted at the point of maximum tenderness. Magnetic resonance imagi ng (MRI) demonstrated diverticulosis of the descending and sigmoid colon. T he patient remained afebrile and received repeated doses of intramuscular a nalgesics and was cleared by the surgical consultant, only to be readmitted with similar symptomatology 24 hours later. Subsequently, following repeat discharge she delivered at 34 weeks' gestation, and developed a small bowe l obstruction during the immediate postpartum course. With the continued fi nding of a left lower abdominal mass and computed tomography findings sugge stive of perforated sigmoid diverticulitis and resulting small bowel obstru ction, laparotomy was performed. Multiple adhesions and phlegmon sequelae o f chronic perforation of the sigmoid were confirmed, and a diverting descen ding colostomy and Hartman's procedure were performed. We present unusual M RI findings of diverticulitis in the third-trimester and review the literat ure pertaining to this unusual complication of pregnancy.