Abstract
A 74-year-old male patient, who had been given an enema 4 days previously due to the absence of bowel movements for 1 week and who had been experiencing lower abdominal pain for 3 days previously, was admitted to our hospital. The patient showed tenderness and rebound tenderness in his left lower abdominal region, and a blood test showed increased inflammatory reaction. Abdominal CT showed abnormal gas distribution into the sigmoid mesocolon and bilateral posterior pararenal spaces via the sigmoid diverticulitis. Based on these data, the patient was diagnosed as having sigmoid diverticulitis that had penetrated the mesentery, and 3 days after onset, he underwent emergency surgery. During the surgery, the presence of mild ascites in the abdominal cavity was confirmed, and the sigmoid diverticulum had penetrated the mesentery. During the surgery, resection of the sigmoid colon, functional end-to-end anastomosis, and abdominal cavity drainage were performed. In the examination of the resected specimen, 2-mm penetration into the mesentery was confirmed on the mucosa. The patient was discharged on post-operative day 23, and the postoperative course was uneventful. It is difficult to confirm the symptoms of peritonitis in patients with penetration of the diverticulum into the mesentery, because the contents of the intestinal tract are covered by the mesenteriolum. Therefore, it is important to make an early diagnosis using abdominal CT and perform surgery when appropriate.
