2003 Volume 23 Issue 6 Pages 931-934
We herein report a case of a ruptured abscess caused by penetrated sigmoid diverticula with gas in the intrahepatic portal system. A 55-year-old man was referred to the hospital because of left lower abdominal pain and fever. On physical examination, there were signs of peritoneal irritation, strongest in the left lower abdomen. Abdominal CT scan revealed gas in the hypertrophic sigmoid mesocolon, which suggested the penetration of the sigmoid diverticula. He underwent conservative treatment with fasting and antibiotics and complete relief of the symptoms was obtained. On the 15th day after admission, he developed a severe abdominal pain and fever. Repeated CT scan revealed increased gas in the mesocolon with gas in the intrahepatic portal system. Laparotomy revealed pan-peritonitis due to rupture of an abscess in the sigmoid mesocolon. The sigmoid colon and the abscess were resected via a Hartmann procedure. The resected specimen revealed sigmoid diverticula penetrating into the abscess in the mesocolon, which had perforated into the free abdominal cavity. The patient's postoperative course was uneventful. Although most gas formation in the intrahepatic portal system is caused by a disturbance in thecuveulation or dilatation of the intestine, this reported case had neither of these conditions. This rare case is the 5th case in the Japanese literature of gas formation in the portal system caused by gas-produced bacteremia.
