Abstract
About 2.7% of diverticula in the digestive tract are found in the small intestine. It is uncommon that diverticulum of the small intestine causes penetration or perforation, but once it occurs, delayed diagnosis can be fatal. We report a case of local peritonitis caused by a penetrated diverticulum in the terminal ileum.
A 67-year-old man was seen at our hospital because of fever and right lower quadrant abdominal pain. Physical examination revealed tenderness and muscle guarding localized in the right lower quadrant of abdomen, suggestive of local peritonitis caused by acute appendicitis or diverticulitis of the ascending colon. An abdominal plain CT scan showed more severe inflammatory changes in the terminal ileum than in the ileocecal region, surrounded by free air. Abnormally high level of CRP was also noted. Emergency laparotomy revealed an inflammatory mass in the ileocecal region, so we resected the terminal ileum and cecum containing the inflammatory mass. The mass was disclosed as mesenteric abscess secondary to perforation of the terminal ileum, 13 cm proximal to the ileocecal valve. The pathological diagnosis was mesenteric abscess caused by a penetrated diverticulum in the terminal ileum.
