Appendicitis and diverticulitis of the colon: Misleading forms

Sibileau, É.; Boulay-Coletta, I.; Jullès, M.C.; Benadjaoud, Samir; Oberlin, O.; Zins, Marc

doi:10.1016/j.diii.2013.03.009

Cited by 12 publications

(12 citation statements)

References 57 publications

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“…[8]. Bowel microperforations can cause pericolic abscess formation, while macroperforations can cause gut-to-gut fistulization and abscess formation throughout the abdomen, including hepatic abscesses [1, 6, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…The intestinal microorganisms are able to cross the gut-vascular barrier and enter the venous circulation either via various virulence factors [11], or via intestinal perforations [12] similar to those caused by diverticulitis. The formation of hepatic abscesses caused by intestinal perforations from diverticulitis has also been documented in the past [6, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…The treatment for diverticulitis includes bowel rest and antibiotics, which is sufficient to resolve symptoms in 75% of cases [5]. However, complications may include microperforations with pericolic abscess formation as well as macroperforations with gut-to-gut fistulization and abscess formation throughout the abdomen [1, 6, 7]. Abscesses may be treated with antibiotics and, depending on size, drainage may be indicated.…”

Section: Introductionmentioning

confidence: 99%

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Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

et al. 2017

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BackgroundPatients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature.Case PresentationA 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved.ConclusionsRefractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

et al. 2017

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“…Radiological anatomy considers an organ to be intraperitoneal when its whole outline is covered with peritoneum, which means that the ascending and descending colons are considered to be ''retroperitoneal'' because of the posterior fusion of their peritoneum with the underlying connective tissue that leaves them in communication with the APR space. We see examples of this relationship, especially in retrocaecal appendicitis or ruptured posterior colonic diverticulitis causing pneumoretroperitoneum with no communication with the peritoneal cavity [7]. The development of the spleen and pancreas, due to the growth of the spleen and its displacement into the left hypochondrium, explains how the head of the pancreas comes to be found in a retroperitoneal position, and this is summarized in Fig.…”

Section: Review Of Peritoneal Radioanatomymentioning

confidence: 96%

Radioanatomy of the retroperitoneal space

Coffin

Boulay-Coletta

Sebbag-Sfez

et al. 2015

Diagnostic and Interventional Imaging

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The retroperitoneum is a space situated behind the parietal peritoneum and in front of the transversalis fascia. It contains further spaces that are separated by the fasciae, between which communication is possible with both the peritoneal cavity and the pelvis, according to the theory of interfascial spread. The perirenal space has the shape of an inverted cone and contains the kidneys, adrenal glands, and related vasculature. It is delineated by the anterior and posterior renal fasciae, which surround the ureter and allow communication towards the pelvis. At the upper right pole, the perirenal space connects to the retrohepatic space at the bare area of the liver. There is communication between these two spaces through the Kneeland channel. The anterior pararenal space contains the duodenum, pancreas, and the ascending and descending colon. There is free communication within this space, and towards the mesenteries along the vessels. The posterior pararenal space, which contains fat, communicates with the preperitoneal space at the anterior surface of the abdomen between the peritoneum and the transversalis fascia, and allows communication with the contralateral posterior pararenal space. This space follows the length of the ureter to the pelvis, which explains the communication between these areas and the length of the pelvic fasciae.

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“…14 It is a difficult to diagnose pathology, not just due to its rarity and no clinical suspicion but also because it mimics other pathologies as: appendicitis, pancreatitis, cholecystitis, perforated duodenal ulcer or even pyelonephritis. 15 In the reported cases, 60% of the patients were diagnosed with acute appendicitis. It is calculated that an average of 3 from 25 cases are diagnosed before going on an invasive procedure.…”

Section: Discussionmentioning

confidence: 99%

Acute perforated transverse colon diverticulitis simulating acute cholecystitis: case report and literature review

et al. 2017

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Transverse colon diverticulitis is a rare entity, described for the first time in 1944 by Thompson and Fox. Even more uncommon if presented with diverticular perforation of the colon. When ranking diverticula distribution by their anatomical location site, it has been set up that transverse colon is involved in an average of 10% of the cases, but diverticulitis or inflammation of these sacculations in this anatomical region only occurs in 0.5-2.5% of the cases. Female, 44 years old, who came to emergency room with acute abdominal pain as colic of 24 hours of evolution, Acute cholecystitis was considered as a first diagnostic possibility. Pain persistence and peritoneal irritation lead to an abdominal contrasted tomography (contrast IV). Oval formations protruding from the gut lumen in ascending and transverse colon were found, corresponding to diverticula. Patient was admitted in hospital and maintained in fasting period and with a double antibiotic scheme she was discharged on the 5th day of hospital stay. Transverse colon diverticulitis is a rare entity, there exist less than 50 cases reported in worldwide literature but it has been determined that patients with transverse colon diverticulitis are 15 and 20 years younger than patients with left colon diverticulitis. That is, average age of manifestation is about 45 years old. 85% of the cases have been described in women. Reports managed it successfully with antibiotics. The present report could be achieved favourably with a double antibiotic scheme, with no need of surgery.

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Appendicitis and diverticulitis of the colon: Misleading forms

Cited by 12 publications

References 57 publications

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

Radioanatomy of the retroperitoneal space

Acute perforated transverse colon diverticulitis simulating acute cholecystitis: case report and literature review

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