Diverticular abscess: unusual clinical and radiographic presentation.

A 73-year-old man presented with bilateral shoulder discomfort. Although the onset of his discomfort seemed to be associated with exertion, there was no chest pain. A month later, a stress test reproduced the shoulder discomfort but again without chest pain. Angiography showed significant coronary artery disease, so the patient was booked for coronary artery bypass grafting 2 months later. Routine preoperative chest radiography showed free intra-abdominal air, so the bypass procedure was cancelled pending investigations. The patient had no complaints of abdominal pain, fever, chills, anorexia, nausea or vomiting. His abdomen was distended and tympanitic, but there was no tenderness or palpable masses. Abdominal radiography showed a large, central, gas-filled cavity occupying much of the abdomen and displacing the small bowel (Fig. 1). Subsequently a fever developed (body temperature 38.4°C). The leukocyte count was 17.2 × 109/L, but no organisms grew on blood culture. Antibiotics were started. An upper gastrointestinal series with Brief Communication Communication abrégée