title: A case of silent perforated diverticulitis in the ascending colon combined with pylephlebitis resulting in complete occlusion of the portal trunk.
abstract: A case of silent perforated diverticulitis in the ascending colon combined with pylephlebitis, resulting in complete occlusion of the portal trunk, is presented. A 75-year-old man with no relevant medical history visited our hospital complaining of a fever, which had lasted for 2 weeks. Although his laboratory data were indicative of severe inflammation, an abdominal examination and a computed tomography (CT) scan did not produce any significant findings. On the 6th day after admission, an abdominal CT scan detected a thrombus extending from the superior mesenteric vein to the portal vein, but did not show any signs of infection. However, on the 40th day after admission, an abdominal CT scan detected an embolus in the portal vein completely occluding the main portal trunk, as well as marked edematous changes indicative of inflammation, and an abscess in the ascending colon. We performed laparotomy and iliocecal resection, during which a perforation of the ascending colon derived from diverticulitis was found. We report this rare case and a review of the literature.
authors.affiliation: Department of Surgery, Nomura Hospital, 8-3-6 Shimorenjaku, Mitaka-shi, Tokyo, 181-8503, Japan, m_fkhr@nomurahp.or.jp.
authors.forename: Michiko
authors.initials: M
authors.lastname: Fukahori
authors.forename: Saito
authors.initials: S
authors.lastname: Shirayama
authors.forename: Ayako
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Takasugi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D044682:Colon, Ascending; D003108:Colonic Diseases / Q000150:complications*; D004238:Diverticulitis / Q000150:complications*; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D010689:Phlebitis / Q000150:complications*; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011859:Radiography; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*