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Perforated diverticulum of the terminal ilenum

A previously unreported cause of suppurative pylephlebitis and multiple hepatic abscesses

Summary

We describe the case of a 58-year-old man who presented to the hospital with central abdominal pain, nausea, fever, chills, and dyspnea. While in the hospital, jaundice appeared and the liver function tests revealed features of both cholestasis and hepatocellular injury. He developed gram-negative septicemia and died on the sixth hospital day. Autopsy disclosed a perforated terminal ileal diverticulum and a contiguous mesenteric abscess. These was also severe phlebitis of mesenteric venous radicles which extended superiorly to the intrahepatic portal venules and veins. The portal veins were surrounded by multiple hepatic abscesses that varied in size from microscopic to 2.5 cm. This appears to be the first report in the world literature of suppurative pylephlebitis and hepatic abscesses resulting from a perforated ileal diverticulum. The subject of small bowel non-meckelian diverticulosis is reviewed because of the rarity of this condition and the diagnostic challenges it poses.

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References

  1. 1.

    Williams RA, Davidson DD, Serota AI, Wilson SE: Surgical problems of diverticular of the small intestine. Surg Gynecol Obstet 152:621–626, 1981

    Google Scholar 

  2. 2.

    Sloan GM, Vineyard GC: Perforated diverticulum of the ileum. Am J Gastroenterol 74:447–450, 1980

    Google Scholar 

  3. 3.

    Herrington JL: Perforation of acquired diverticula of the jejunum and ileum. Surgery 51:426–433, 1962

    Google Scholar 

  4. 4.

    Wolper JC, Tisnado J: Perforation and hemorrhage of a non-Meckelian ileal diverticulum. Preoperative angiographic diagnosis. Dig Dis Sci 26:565–567, 1981

    Google Scholar 

  5. 5.

    Maull KI, Nicholson BW, Mendez-Ricon G: Jejunoileal diverticulosis. South Med J 74:792–795, 1981

    Google Scholar 

  6. 6.

    Meng RL, Gardiner R, Banich T, Banich F: Ileovesical Fistula: A rare complication of ileal diverticulitis. Can J Surg 24:74–76, 1981

    Google Scholar 

  7. 7.

    Roses DF, Gouge TH, Scher KS, Ranson JHC: Perforated diverticla of the jejunum and ileum. Am J Surg 132:649–652, 1976

    Google Scholar 

  8. 8.

    Smith JS: Jejunal diverticula—subtle cause of acute abdomen. Pa Med 79:60–63, 1976

    Google Scholar 

  9. 9.

    Miller RE, McCabe RE, Salomon PF, Knox WG: Surgical complications of small bowel diverticula exclusive of Meckel's. Ann Surg 171:202–210, 1970

    Google Scholar 

  10. 10.

    Patankar VJ: Multiple ileal diverticula associated with perforation and peritonitis. J Indian Med Assoc 46:452–453, 1966

    Google Scholar 

  11. 11.

    Altemeier WA, Bryant LR, Wulsin JH: The surgical significance of jejunal diverticulosis. Arch Surg 86:732–745, 1963

    Google Scholar 

  12. 12.

    Delaney EW, Hedges RC: Acquired ileal diverticulosis and hemorrhagic diverticulitis. Gastroenterology 42:56–59, 1962

    Google Scholar 

  13. 13.

    Mydland WE, Spackman LF, Mason VT: An interesting complication of jejuno-ileal diverticulitis. Can J Surg 4:96–98, 1960

    Google Scholar 

  14. 14.

    Lee RE, Finby N: Jejunal and ileal diverticulosis. Arch Intern Med 102:97–102, 1958

    Google Scholar 

  15. 15.

    Koletsky S: Ruptured diverticulum of the ileum. Ohio Med J 37:1078, 1941

    Google Scholar 

  16. 16.

    Adams-Ray J: A Unique case of subcutaneous abdominal injury with intramesenteric rupture of the diverticulum of the small intestine, and subsequent peritonitis. Acta Chir Scand 81:398–403, 1938

    Google Scholar 

  17. 17.

    Fraser I: The diverticula of the jejuno-ileum. Br J Surg 21:183–211, 1933

    Google Scholar 

  18. 18.

    Demling L, Elster K, Koch H, Rösch W:In Endoscopy and Biopsy of Esophagus, Stomach and Duodenum, Soergel KH (Trans.) 2nd ed. Philadelphia, WB Saunders, 1982, p 43

    Google Scholar 

  19. 19.

    Spiro HM: Clinical Gastroenterology, 3rd ed. New York, Macmillan, 1983, p 220

    Google Scholar 

  20. 20.

    Eckhauser FE, Zelenock GB, Freier DT: Acute complications of jejuno-ileal pseudodiverticulosis. Surgical implications and management. Am J Surg 138:320–323, 1979

    Google Scholar 

  21. 21.

    Barner L, Doldt H, Strecker EP: Dunndarm-divertikulose mit Diverticulitis. Radiologe 20:552–553, 1980

    Google Scholar 

  22. 22.

    Rodriguez Cuartero A, Urbano Jimenez F, Vilches Medina J: Diverticulos de intestino delgado (excluido duodeno). Rev Clin Esp 150:189–192, 1978

    Google Scholar 

  23. 23.

    Cronan JJ, Kocoshis S, Gryboski JD, Ablow RC: Occult blood loss in a 17-year-old secondary to small bowel diverticula. J Clin Gastroenterol 2:161–164, 1980

    Google Scholar 

  24. 24.

    Giuidici V, Bersani B, Crespi F, Bianchi G: Occlusione intestinale da diverticulosi dell' ileo. Minerva Chir 35:1307–1312, 1980

    Google Scholar 

  25. 25.

    Donald JW: Major complications of small bowel diverticula. Ann Surg 190:183–188, 1979

    Google Scholar 

  26. 26.

    Benson RE, Dixon CF, Waugh JM: Non-Meckelian diverticula of the jejunum and ileum. Ann Surg 118:377–393, 1943

    Google Scholar 

  27. 27.

    Rankin FW, Martin WJ, Jr: Diverticula of the small bowel. Ann Surg 100:1123–1135, 1934

    Google Scholar 

  28. 28.

    Dodson RM: Diverticulosis of the small intestine. West J Surg 49:143–146, 1941

    Google Scholar 

  29. 29.

    Walker RM: The complicationis of acquired diverticulosis of the jejunum and ileum. Br J Surg 32:457–463, 1945

    Google Scholar 

  30. 30.

    Butler RW: Observations upon multiple intramesenteric diverticula of the small intestine. Br J Surg 21:329–345, 1933

    Google Scholar 

  31. 31.

    Stiven HFS: Jejuno-ileal diverticulitis. Lancet 2:704–705, 1934

    Google Scholar 

  32. 32.

    Waxman BP, Cavanagh LL, Nayman J: Suppurative pylephlebitis and multiple hepatic abscesses with silent colonic diverticulitis. Med J Aust 2:376–378, 1979

    Google Scholar 

  33. 33.

    McKenzie CG: Pyogenic infection of liver secondary to infection in the portal drainage area. Br Med J 2:1558–1563, 1964

    Google Scholar 

  34. 34.

    Jones CA: Diseases of the hepatic blood vessels.In Gastroenterology, Vol III, 2nd ed. HL Bockus (ed). Philadelphia, WB Saunders, 1965, p 447

    Google Scholar 

  35. 35.

    Kramer SE, Robinson W: Acquired suppurative diverticulitis with pylephlebitis and metastatic suppuration in the liver. Report of a case. Surg Gynecol Obstet 42:540–542, 1926

    Google Scholar 

  36. 36.

    Lin C: Suppurative pylephlebitis and liver abscess complicating colonic diverticulitis. Report of two cases and review of literature. Mt Sinai J Med 40:48–55, 1973

    Google Scholar 

  37. 37.

    Taylor FW: Regional enteritis complicated by pylephlebitis and multiple liver abscesses. Am J Med 7:838–840, 1949

    Google Scholar 

  38. 38.

    Case Records of the Massachusetts General Hospital: Case 18–1977. N Engl J Med 296:1051–1057, 1977

    Google Scholar 

  39. 39.

    Clain D, Gelfand M: Jaundice and pneumonia in the African. Cent Afr J Med 10:217–221, 1964

    Google Scholar 

  40. 40.

    Zimmerman JH, Fang M, Ricardo V, Seef LB, Hoofnagle J: Jaundice due to bacterial infection. Gastroenterology 77:362–374, 1979

    Google Scholar 

  41. 41.

    Neale G, Caughey DR, Mollin DL, Booth CC: Effects of intrahepatic and extrahepatic infection on liver function. Br Med J 1:382–387, 1966

    Google Scholar 

  42. 42.

    Lazarchick J, DeSouza E, Silva NA: Pyogenic liver abscess. Mayo Clin Proc 48:349–355, 1973

    Google Scholar 

  43. 43.

    Rubin RH, Swartz MN, Malt R: Hepatic abscess: Changes in clinical, bacteriologic and therapeutic aspects. Am J Med 57:601–610, 1974

    Google Scholar 

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Correspondence to Carlos Navarro MD.

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Navarro, C., Clain, D.J. & Kondlapoodi, P. Perforated diverticulum of the terminal ilenum. Digest Dis Sci 29, 171–177 (1984). https://doi.org/10.1007/BF01317061

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Keywords

  • Small Bowel
  • Portal Vein
  • Ileal
  • Liver Function Test
  • Cholestasis