RADIOLOGY: GASTROINTESTINAL: GI: Case# 32829: HIATAL HERNIA W/ TX COLON AND DIVERTICULITIS. This is a 71 year old male with previous barium enema suggestive of diverticulitis. Moderate sized posterior diaphragmatic hernia with herniation of segments of the hepatic flexure and transverse colon. No evidence of bowel strangulation. Multiple diverticula are within the descending and sigmoid colon. The sigmoid colon demonstrates a thickened wall with inflammatory changes involving the surrounding mesenteric fat. No air-fluid level suggestive of abscess is identified. The hallmark of diverticulitis on CT is the presence of diverticula with surrounding pericolonic inflammation. There may be accompanying circular muscular hypertrophy. The wall of the colon is usually thickened. About one-third of patients will present with a diverticular abscess. Diverticular abscess appears as a soft tissue mass with a thick wall and a low attenuation center which may also contain gas or luminal contrast material.