Large ventral hernia with ileal diverticulitis within the hernial sac and enterocutaneous fistula
Presentation
Presents with abdominal swelling with pus discharge from anterior abdominal wall of right iliac fossa. History of hysterectomy in past.
Patient Data
Contrast enhanced CT scan of abdomen shows large infraumbilical midline and right paramedian incisional ventral hernia containing right half of transverse colon, ascending colon, cecum, appendix and ileal loops. The defect measures 12.0 x 8.5 cm (transverse x craniocaudal) in maximum dimensions.
There is a thick walled diverticulum arising from the anti-mesenteric border of one of the herniated ileal loops in inferomedial portion of the hernial sac measuring 3.0 x 3.1 x 2.4 cm. The diverticulum shows thickened, enhancing walled with mottled intraluminal contents- suggestive of acute ileal diverticulitis.
Fistulous communication is seen between the inflamed ileal diverticulum and the skin of adjacent anterior abdominal wall - suggestive of enterocutaneous fistula. Small enterolith is seen in the diverticulum.
Uterus is surgically absent.
Case Discussion
60 year old female with past hysterectomy presented with abdominal swelling and recent onset pus discharge in right iliac fossa.
CT abdomen showed large midline and right paramedian, infraumbilical ventral incisional hernia containing right half of transverse colon, ascending colon, cecum, appendix and ileal loops.
Inflamed ileal diverticulum was seen in inferomedial portion of hernial sac with enterocutaneous fistula between the inflamed diverticulum and adjoining skin.
Enterocutaneous fistulas are seen as a complication of Crohn's disease, post-abdominal surgery or other inflammatory bowel diseases.
Ileal diverticulae are usually asymptomatic. If symptomatic, they mimic appendicitis clinically.
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