Chronic diverticulitis complicated by hepatic abscess and portal vein thrombosis

Case contributed by RMH Core Conditions

Presentation

Right upper quadrant pain. Septic shock.

Patient Data

Age: 50 years
Gender: Male

Interposed between a 10-15cm segment of markedly thick walled sigmoid colon and the superior surface of the bladder is a 2.0 x 2.6 x 2.5 cm gas and fluid containing collection with an irregular enhancing wall and some surrounding fat stranding. The marked sigmoid diverticulosis in this region makes a contained diverticular abscess the most likely etiology.

Intrahepatic portal vein thrombosis, no enhancing tumor thrombus detected. Patent hepatic veins. When directly compared with the previous CT the size and number of low density hepatic lesions has increased considerably in three days, consistent with hepatic abscesses. Moderate volume dependent free intraperitoneal fluid. No pneumoperitoneum identified. Bilateral basal collapse and moderate pleural effusions.

Case Discussion

Key learning points:

  • when hepatic abscess are demonstrated the colon should be carefully reviewed as it is a common source

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