Perforation of a Diverticulum of the Terminal Ileum with Superior Mesenteric Venous Thrombosis and Cholecystitis—A Case Report—

Abstract

Superior mesenteric venous (SMV) thrombosis is a rare complication of diverticulitis, and mesenteric venous thrombosis (MVT) is a serious condition that can lead to debilitating intestinal ischemia. A 62-year-old man presented with fever-related right abdominal pain, no medical history, and no thrombotic predisposition. Imaging including contrast-enhanced computed tomography (CT) showed perforation of the terminal ileum, SMV thrombosis, and cholecystitis. After one month of anticoagulant and antibacterial treatment for venous thrombotic sepsis, his systemic symptoms were alleviated with the development of collateral circulation. To prevent recurrence, laparoscopic ileocecal resection and cholecystectomy were performed simultaneously. After three-month oral anticoagulant therapy, contrast-enhanced CT demonstrated alternative venous development compensating for the lacking SMV flow. Japanese guidelines for diverticulitis did not mention MVT associated with diverticulitis, but the present case report provides novel evidence that a surgical approach after a medical approach is a valid treatment for a perforated diverticulum of the terminal ileum with SMV thrombosis.