Pneumopylephlebitis and intramesocolic diverticular perforation

Hepatic-portal venous gas in acute colonic diverticulitis

“…Noteworthy observations from this table include the universal (i.e., sigmoidal) origin of inflammation, the constant presence of a mesocolic abscess, and the fact that almost always bacteremia, often polymicrobial, is reported. It has been suggested, that HPVG in acute colonic diverticulitis is associated with mesocolic abscess caused by intramesocolic perforation, dissecting between the peritoneal leaflets of the mesocolon and creating access to mesocolic veins [5]. In fact, in the majority of cases operated upon, as in the case presented here, the mesocolic veins revealed signs of perivascular inflammation.…”

“…However, for cases of HPVG associated with synchronous liver abscess, overall mortality rates remain in the range of 40-53% [16,17]. Moreover, all patients suffering from acute sigmoid diverticulitis complicated by liver abscess and HPVG eventually died [3,5]. It would therefore appear that synchronous occurrence of liver abscess and HPVG in a patient with complicated sigmoid diverticulitis signifies an advanced septic complication, and if detected by ultrasound, mandates urgent surgical intervention.…”

Mediastinal, retroperitoneal, and subcutaneous emphysema due to sigmoid colon penetration: A case report and literature review

“…Perforation of diverticulitis is one of the most serious complications and requires an urgent operation. In some previous reports, colonic perforation resulted in a free hole occurring on the opposite side of the mesentery [12,13]. In cases of free perforation, clinical features include massive free air on CT and signs of peritoneal irritation; thus, it is easy to diagnose this early.…”