Colonic diverticulitis with portal vein gas

Case contributed by Ahmed Montasr
Diagnosis almost certain

Presentation

Severe pelvic pain.

Patient Data

Age: 45 years
Gender: Male

A pathological process is seen involving the sigmoid colon displaying mural thickening with few diverticular outpouchings and para-colic loculated collection showing internal septations and marginal enhancement with surrounding smudging of the fat planes.

Such process is seen closely related to the peri-colic veins with noted dilated inferior mesenteric vein showing internal filling defect and intraluminal air loculi reaching cranially the splenic vein level.

The liver is enlarged with alternating areas of attenuation differences (perfusional defects) in the form of areas of hypoperfusion. No pathologically enhancing lesions.

The main portal vein appears dilated showing partial thrombosis and intraluminal air extending into the splenic vein and the intrahepatic branches.

Moderate pelvic ascites.

Mildly enlarged spleen.

Scanned lung bases show bilateral pleural effusion.

Diffuse anterior abdominal wall subcutaneous edema.

Case Discussion

This is a case of a pathological process involving the sigmoid colon of complicated diverticulitis with diverticular abscess formation complicated with portal circulation partial thrombosis and venous gas loculi.

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