Pneumopylephlebitis and intramesocolic diverticular perforation.

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Diverticulitis is a common condition, but intramesocolic perforation is a rare and often insidious complication.
• Pneumopylephlebitis, air in the portal venous system, can be associated with intra-abdominal infections.

Observation:

• Two cases of intramesocolic perforation associated with pneumopylephlebitis are reported.
• Previously reported cases of pneumopylephlebitis secondary to diverticular perforation may represent intramesocolic perforations.

Findings:

• Intramesocolic perforation presents insidiously, making early diagnosis challenging.
• Pneumopylephlebitis in the context of diverticulitis strongly suggests intramesocolic perforation.

Implications:

• Exploratory laparotomy is indicated for suspected pneumopylephlebitis.
• Water-soluble contrast enema is recommended for recurrent sepsis of unknown origin.
• Failure of conservative management warrants exploratory laparotomy to rule out intramesocolic abscess.