PMC6662477_01
Spastic reflex ileum (gasless abdomen).
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fig1
Abdominal X-ray was performed showing a poor representation of small and large bowel meteorism with no associated pathological air-fluid levels, as from spastic reflex ileus (Figure 1).
US image of the left lower quadrant with high frequency probe shows an oval noncompressible mass (calliper) with heterogeneous echotexture, located at the point of maximum tenderness.
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fig2
US (Logiq e7  GE Healthcare, USA) was performed using a high frequency linear probe (7,5 - 13Mhz) for the direct visualization of the descending and sigmoid colon in the left iliac fossa, because of the clinical suspicion of diverticulitis. US revealed a moderate reactive bowel wall thickening of the descending and the sigmoid colon with inflammatory change in the pericolonic fat, appearing as adjacent oval noncompressible hyperechoic mass, without internal vascularity and surrounded by a subtle hypoechoic line (Figure 2).
Axial (a) and coronal (b) contrast enhancement CT images show an oval pericolonic fat-density nodule (arrow) with a hyperdense ring and surrounding inflammation.
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fig3
According to the clinical conditions of the patient and the suggestive US findings, CT (128-slice Multidetector CT scanner GE Revolution GSI , GE Healthcare, USA) scanning of the abdomen/pelvis with 120mL IV of iomeprol contrast media (Iomeron 400  Bracco, Italy) was also performed, confirming a moderate reactive wall thickening of the descending and the sigmoid colon with a nonenhancing adjacent fat-density ovoid structure characterized by a high-density rim and a surrounding inflammatory fat stranding (Figure 3).