A Case of Penetrated Ileal Diverticulum Diagnosed Preoperatively by Multiplanar Reconstruction of CT Images

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  • Niwa Hiroki
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital Department of Gastroenterological Surgery Ⅱ, Hokkaido University Graduate School of Medicine
  • Takahashi Ryo
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital
  • Suzuoki Masato
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital
  • Wada Hideyuki
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital
  • Mizunuma Kenichi
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital
  • Ueki Tomone
    Department of Surgery, National Hospital Organization (NHO) Hakodate National Hospital
  • Kimura Noriko
    Department of Pathology, National Hospital Organization (NHO) Hakodate National Hospital
  • Hirano Satoshi
    Department of Gastroenterological Surgery Ⅱ, Hokkaido University Graduate School of Medicine

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Other Title
  • 術前診断にCTのMPR画像が有用であった回腸憩室穿通の1例
  • ジュツゼン シンダン ニ CT ノ MPR ガゾウ ガ ユウヨウ デ アッタ カイチョウ ケイシツセンツウ ノ 1レイ

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<p>We report the case of a patient in whom a penetrating ileal diverticulum was diagnosed preoperatively. A 77-year-old man was admitted to our hospital with a week’s history of fever, vomiting, and abdominal pain. He had right lower abdominal pain but there were no signs of peritoneal irritation. Multiplanar reconstruction (MPR) of plain CT images revealed a diverticulum in the terminal ileum, increased density of the surrounding fatty tissue, and air. Based on these findings, we made the diagnosis of penetrating ileal diverticulum into the mesentery. Although conservative treatment was selected, the abdominal pain and blood test abnormalities worsened on the third day of hospitalization, and laparoscopic ileocecal resection was performed. The resected specimen showed penetration of the diverticulum into the mesentery at 4 cm from the ileocecal valve. Since a penetrating ileal diverticulum often does not respond to conservative treatment, it is necessary to differentiate it from appendicitis or ascending colon diverticulitis. For diagnosis, MPR of CT images are very useful, as they were in our case, and surgical treatment should be aggressively considered as soon as possible after the diagnosis.</p>

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