Abstract
A 68-year-old man was evaluated for a chief complaint of right lower abdominal pain and fever. Contrast CT showed perforation of the mesenteric small bowel and a mesenteric abscess. The suspected cause was a diverticulum, but a malignant tumor could not be ruled out. Since the patient was otherwise in good general health, and the abdominal pain was localized, he was managed conservatively and further evaluated. Colonoscopy showed a submucosal protrusion in the terminal ileum. One month after the onset of abdominal pain, the inflammatory findings subsided, but a malignancy could still not be excluded. Therefore, elective laparoscopic surgery was performed. The findings showed a small bowel pseudodiverticulum with mesenteric perforation.
A small intestinal pseudodiverticulum with perforation is relatively rare, difficult to diagnose preoperatively, and emergency surgery is often performed. Although the present patient had a mesenteric abscess due to diverticular perforation, he was successfully managed by conservative therapy, followed by elective laparoscopic surgery to resect the lesion. In patients with a small bowel mesenteric abscess but localized inflammation, elective laparoscopic surgery is a less invasive procedure.
