Chronic diverticulitis complicated by hepatic abscess and portal vein thrombosis
Right upper quadrant pain. Septic shock.
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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 aetiology.
Intrahepatic portal vein thrombosis, no enhancing tumour 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.
Key learning points:
- when hepatic abscess are demonstrated the colon should be carefully reviewed as it is a common source