Figure 1
Teaching Case
SectionAbdominal imaging
Case TypeClinical Cases
Authors
Connected authors
61 years, male
A 61-year-old man was admitted to the Accidents and Emergency department with left iliac fossa pain and vomiting.
Increasing lactate in spite of intravenous fluids.
Clinically perforated sigmoid diverticulum.
Increasing lactate in spite of intravenous fluids.
Clinically perforated sigmoid diverticulum.
Septic thrombophlebitis of inferior mesenteric vein due to sigmoid diverticulitis
Diverticular abscess and perforation
Ischaemic large bowel
AXR- No free gas under the diaphragm. No bowel obstruction or air fluid level in the left iliac fossa.
CT abdomen- Sigmoid diverticular disease with inflammatory changes in the adjoining mesentery.
Inferior mesenteric vein was not opacified and showed fat stranding throughout the drainage course into the splenic vein.
At the site of entry into the splenic vein there was a filling defect suggesting splenic venous thrombus.
Portal vein and the right branch of portal vein show intraluminal thrombus.
Superior mesenteric vein, infrahepatic IVC were normal.
No free fluid or free air in the abdomen.
Incidental ankylosing spondylosis.
CT abdomen- Sigmoid diverticular disease with inflammatory changes in the adjoining mesentery.
Inferior mesenteric vein was not opacified and showed fat stranding throughout the drainage course into the splenic vein.
At the site of entry into the splenic vein there was a filling defect suggesting splenic venous thrombus.
Portal vein and the right branch of portal vein show intraluminal thrombus.
Superior mesenteric vein, infrahepatic IVC were normal.
No free fluid or free air in the abdomen.
Incidental ankylosing spondylosis.
The patient was admitted with left iliac fossa pain and high lactate which did not improve over next 24 hours despite supportive measures and the clinical suspicion changed from diverticulitis to perforation/ischaemic bowel.
Initial abdominal X-ray was within normal limits and follow-up CT showed sigmoid diverticulitis. Draining veins were not opacified suggesting occlusion and there was surrounding inflammation throughout the course of the inferior mesenteric vein suggesting septic thrombophlebitis of the inferior mesenteric vein.
Complications of diverticular disease in acute presentation include diverticulitis, localised perforation/ abscess and very rarely thrombophlebitis.
Septic thrombophlebitis of a mesenteric vein is rare complication of diverticulitis.
The patient is currently being medically managed with antibiotics and anticoagulants. [1, 2, 3]
Initial abdominal X-ray was within normal limits and follow-up CT showed sigmoid diverticulitis. Draining veins were not opacified suggesting occlusion and there was surrounding inflammation throughout the course of the inferior mesenteric vein suggesting septic thrombophlebitis of the inferior mesenteric vein.
Complications of diverticular disease in acute presentation include diverticulitis, localised perforation/ abscess and very rarely thrombophlebitis.
Septic thrombophlebitis of a mesenteric vein is rare complication of diverticulitis.
The patient is currently being medically managed with antibiotics and anticoagulants. [1, 2, 3]
References
[1] Cazalas G, Mattei S, Martin B, Hornez E, Marciano-Chagnaud S, Moutardier V, Chaumoitre K. (2010) [Inferior mesenteric vein gas and septic thrombophlebitis secondary to sigmoid diverticulitis]. J Radiol 91(1 Pt 1):75-7 (PMID: 20212382)
[2] Nobili C, Uggeri F, Romano F, Degrate L, Caprotti R, Perego P, Franciosi C, Uggeri F. (2007) Pylephlebitis and mesenteric thrombophlebitis in sigmoid diverticulitis: medical approach, delayed surgery. Dig Liver Dis 39(12):1088-90 (PMID: 17644055)
[3] Domajnko B, Kumar A, Salloum RM. (2007) Mesenteric venous thrombophlebitis--septic thrombophlebitis of the inferior mesenteric vein: an unusual manifestation of diverticulitis. Am Surg 73(4):404-6 (PMID: 17439039)
Case information
| URL: | https://www.eurorad.org/case/11445 |
| DOI: | 10.1594/EURORAD/CASE.11445 |
| ISSN: | 1563-4086 |
Figure 2
Figure 3
Figure 4
Figure 5
Figure 1
Southampton Hospital NHS Trust
Figure 2
Southampton General Hospital NHS Trust
Figure 3
Southampton General Hospital NHS Trust
Figure 4
Southampton General Hospital NHS Trust.
Figure 5
Southampton General NHS Trust