Abstract
A 79-year-old woman complaining of lower abdominal pain had high fever, 39°C, and tenderness in the right lower quadrant of abdomen. There was minor degree of peritoneal signs as well. Blood biochemical examinations showed inflammatory findings. An abdominal CT scan revealed a small amount of ascites in the pelvic cavity, thickening of the ileum wall, and an increased fat density around the ileum. Peritonitis was likely, and laparoscopic-assisted surgery was performed. There was moderate volume of turbid ascites in the pelvic cavity and the ileum had adhered to the pouch of Douglas. After ablation of the adhesions, a midline incision about 4 cm in length was made in the lower abdomen. We found an abscess, which had ruptured, in the mesentery of the adhered ileum. No perforations were seen in the ileum, but cicatrization of the mesentery had occurred and narrowing part was confirmed in the ileum. Resection of the small intestine was thus performed. No perforation was found in the ileum. Idiopathic mesenteric abscess was diagnosed. Histopathological findings showed remarkable infiltration of inflammatory cells in the small intestine mesentery. Old thrombi were observed in the mesenteric vessels, indicating that some factors disturbing the blood stream might exist there. Further, bacteriological culture of the ascites resulted in negative.
Few cases of idiopathic mesenteric abscess have been reported and our case is presented here, together with a review of the literature.
