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Pneumopylephlebitis and intramesocolic diverticular perforation
Abstract:
The insidious presentation of intramesocolic perforation in diverticulitis has been reviewed, and two cases of intramesocolic perforation associated with pneumopylephlebitis have been reported. Review of the two previously reported cases of pneumopylephlebitis associated with diverticular perforation suggests that these may have been intramesocolic perforations as well. Exploratory laparotomy is clearly indicated in cases of pneumopylephlebitis. In patients with recurrent sepsis without a probable source, a water-soluble contrast enema is recommended. If conservative measures fail, an exploratory laparotomy should be performed to exclude intramesocolic abscess.
Insights
Intramesocolic perforation in diverticulitis can be insidious. Pneumopylephlebitis suggests this rare complication, necessitating exploratory laparotomy or contrast enema for diagnosis and treatment.
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.