Image 36: This 72 year old Korean male presented with right sided abdominal pain and tenderness. He gave a history of a acute liver fluke infection 10 years earlier which was treated successfully with praziquantel. His WBC was 13.7 x109/L and eosinophils 0.27 x109/L; his liver enzymes and creatinine were normal. A barium enema was as shown. What was the diagnosis?
	ascending colon

di

Image 36: Diverticulitis associated with multiple diverticuli in the ascending colon. An ultrasound revealed a phlegmon adjacent to the ascending colon. It resolved with several weeks of antibiotics. This picture is quite atypical in the non-oriental North American and European experience, where only 1.5 % of diverticulitis cases involve the ascending colon (Fischer MG, Farkas AM. Dis Colon Rectum 27:454-8; 1984). In a study in Japan, 70 % of diverticulosis cases were right sided and only 16% left sided. (Sugihara K et al Dis Colon Rectum 27; 531-7; 1984). Similar studies from Hong Kong and Singapore confirm these geographic differences.