A Case of Intramesenteric Penetration of Sigmoid Colon Diverticulitis Successfully Treated with Drainage and Subsequent Radical Surgery Using Reduced Port Laparoscopic Procedures

Abstract

While drainage is essential in the treatment of perforated diverticulitis accompanied by an abscess, a therapeutic strategy including surgical drainage is needed when percutaneous drainage is difficult. We report herein on a case of sigmoid colon diverticulitis accompanied by an intramesenteric abscess treated less invasively with a planned two–step laparoscopic surgery. A 36–year–old man was referred to our hospital with a diagnosis of sigmoid colon diverticulitis accompanied by an intramesenteric abscess. At the first surgery, a small laparotomy was made at the right lower quadrant and laparoscopic drainage was performed using an access device inserted at the laparotomy site. A temporary ileostomy was subsequently made at the site of the laparotomy. Three months after the first surgery, the second surgery was performed. The ileostomy was closed at first, and an access device was again inserted at the same site. A laparoscopic sigmoidectomy was performed in the usual manner. The patient was discharged 7 days after surgery. A radical laparoscopic surgery with primary anastomosis was safely accomplished owing to adequate control of local inflammation, resulting in avoidance of a permanent colostomy. Effective utilization of an access device enabled the sequence of surgical procedures with only one small laparotomy incision. This sequential procedure seems to be useful when percutaneous drainage is difficult.