Diagnostic Imaging Pathways - Iliac Fossa Pain (Acute Left)

{tab=Pathway Home}

Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with left iliac fossa pain, with emphasis on investigations for suspected diverticulitis and its complications.

Date reviewed: January 2012

Date of next review: 2017/2018

Published: January 2012

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


Pathway Diagram


Image Gallery

Note: These images open in a new page
1a Click to view full size image


Image 1a (Computed Tomography): Inflammatory changes are seen around the sigmoid colon without abscess formation (arrow).

1b Click to view full size image Image 1b (Computed Tomography): Sigmoid diverticulitis complicated by an abscess (arrow).
2a Click to view full size image Diverticular Disease

Image 2a: Sigmoid colectomy showing multiple diverticular outpouchings through the bowel wall. Note the attenuated muscularis propria (black arrows) compared to the normal muscle layer (blue arrow).

2b Click to view full size image Image 2b (H&E, x2.5): Histological section showing an uninflamed diverticulum extending through the muscularis propria of the large bowel wall.

{tab=Teaching Points}

Teaching Points


Acute Left Iliac Fossa / Pelvic Pain




Double Contrast Barium Enema (DCBE)


Transabdominal / Transvaginal Ultrasound


Plain Radiography


Computed Tomography (CT)



References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Stollman NH, Raskin JB, et al. Practice guidelines: Diagnosis and management of diverticular disease of the colon in adults. Am J Gastroenterol. 1999;94(11):3110-21. (Evidence based guidelines)
  2. McKee RF Deignan RW, Krukowski ZH. Radiological investigation in acute diverticulitis. Br J Surg. 1993;80:560-5. (Review article)
  3. O'Malley ME, Wilson SR. Ultrasonography and computed tomography of appendicitis and diverticulitis. Semin Roentgenol. 2001;36(2):138-47. (Review article)
  4. Rao PM. CT of diverticulitis and alternative conditions. Semin Ultrasound CT MR. 1999;20(2):86-93. (Review article)
  5. Ambrosetti P, Grossholz M, Becker C, et al. Computed tomography in acute left colonic diverticulitis. Br J Surg. 1997;84:532-4. (Level II/III evidence)
  6. Cho KC, Morehouse HT, Alterman DD, et al. Sigmoid diverticulitis: diagnostic role of CT- comparison with barium enema studies. Radiology. 1990;176:111-5. (Level II/III evidence)
  7. Rao PM, Rhea JT, Novelline RA, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol. 1998;170:1445-9. (Level II evidence). View the reference
  8. Eggesbo HB, Jacobsen T, Kolmannskog F, et al. Diagnosis of acute left sided colonic diverticulitis by three radiological modalities. Acta Radiologica. 1998;39:315-21. (Level II/III evidence)
  9. Neff CC, vanSonnenberg E, Casola G, et al. Diverticular abscesses: percutaneous drainage. Radiology. 1987;163:15-8. (Level III evidence)
  10. Stabile Be, Puccio E, van Sonnenberg E, et al. Preoperative percutaneous drainage of diverticular abscesses. Am J Surg. 1990;159:99-105. (Level III evidence)
  11. Chintapalli KN, Chopra S, Ghiatas AA, et al. Diverticulitis versus colonic cancer: differentiation with helical CT findings. Radiology. 1999;210:429-35. (Level II evidence). View the reference
  12. Bau A, Atri M. Acute female pelvic pain: Ultrasound evaluation. Semin Ultrasound CT MR. 2000;21:78-93. (Review article)
  13. Zielke A, Hasse C, Nies C, et al. Prospective evaluation of ultrasonography in acute colonic diverticulitis. Br J Surg. 1997;84:385-8. (Level II evidence). View the reference
  14. Pradel JA, Adell JF, Taourel P, et al. Acute colonic diverticulitis: prospective evaluation with US and CT. Radiology. 1997;205:503-12. (Level II evidence). View the reference
  15. Verbanck J, Lambrecht S, Rutgeerts L, et al. Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study. J Clin Ultrasound. 1989; 17: 661-6. (Level II evidence). View the reference

Further Reading

  1. Gore RM, Miller F, Pereles FS, Yaghmai V, Berlin JW. Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol. 2000;174:901-13. (Review article)
  2. Urban BA, Fishman EK. Targeted helical CT of the acute abdomen: appendicitis, diverticulitis, and small bowel obstruction. Semin Ultrasound CT MR. 2000;21:20-39. (Review article)
  3. Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998;338(21):1521-6. (Review article)

{tab=Information for Consumers}

Information for Consumers

Information from this website

Information from the Royal Australian and New Zealand College of Radiologists’ website

Radiation Risks of X-rays and Scans

Computed Tomography (CT)


Plain Radiography (X-ray)

Computed Tomography (CT)

Iodine-Containing Contrast Medium

Plain Radiography/X-rays

Radiation Risk of Medical Imaging During Pregnancy

Radiation Risk of Medical Imaging for Adults and Children




© Copyright 2015, Department of Health Western Australia. All Rights Reserved. This web site and its content has been prepared by The Department of Health, Western Australia. The information contained on this web site is protected by copyright.

Legal Notice

Please remember that this leaflet is intended as general information only. It is not definitive and The Department of Health, Western Australia can not accept any legal liability arising from its use. The information is kept as up to date and accurate as possible, but please be warned that it is always subject to change


File Formats

Some documents for download on this website are in a Portable Document Format (PDF). To read these files you might need to download Adobe Acrobat Reader.

Get Adobe Reader