A Case Report of Modified Hinchey II Colonic Diverticulitis Complicating Portal Vein Thrombosis Treated with Elective Surgery

DOI Web Site 21 References
  • Yamaguchi Hiroshi
    Department of Surgery, Higashi-Sapporo Hospital Department of Surgery, Surgical Oncology and Science, Sapporo Medical University
  • Kashiwagi Kiyoteru
    Department of Surgery, Higashi-Sapporo Hospital
  • Kihara Chikashi
    Department of Surgery, Sapporo Doto Hospital
  • Kuga Yoko
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Department of Breast Surgery, Higashi-Sapporo Hospital
  • Ito Satoko
    Department of Internal Medicine, Higashi-Sapporo Hospital
  • Watanabe Nanae
    Department of Internal Medicine, Higashi-Sapporo Hospital
  • Kondo Nobuo
    GeneticLab Co., Ltd.
  • Imamura Masafumi
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University
  • Nagayama Minoru
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University
  • Nobuoka Takayuki
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University
  • Kimura Yasutoshi
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University
  • Ohmura Tosei
    Department of Breast Surgery, Higashi-Sapporo Hospital
  • Hata Fumitake
    Department of Surgery, Sapporo Doto Hospital
  • Takemasa Ichiro
    Department of Surgery, Surgical Oncology and Science, Sapporo Medical University

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Other Title
  • 門脈血栓症を合併したmodified Hinchey IIの結腸憩室炎に対して待機的手術を施行した1例

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Abstract

<p>A 77-year-old male patient presented to our hospital with a chief complaint of lower abdominal pain. Plain CT on admission demonstrated peri-appendiceal and intrapelvic fluid collections with multiple diverticula in the right colon, without an identified appendix, suggesting peri-appendiceal and intrapelvic abscesses caused by appendicitis or diverticulitis. Due to the general condition being impaired, conservative antimicrobial treatment was initiated. Portal vein thrombosis was subsequently diagnosed by contrast-enhanced CT on hospital day 4, and treated with heparin and antithrombin III. The patient resumed an oral diet on hospital day 14, and anticoagulation therapy was switched to edoxaban per-oral. He was discharged on hospital day 29. Post-discharge close examination revealed no abnormality in the appendix, leading to a diagnosis of portal vein thrombosis complicating an intra-abdominal abscess caused by diverticulitis. Laparoscopic right hemicolectomy was performed 3.5 months after initial discharge, after which the patient was discharged uneventfully. There has been no evidence of exacerbation of portal vein thrombosis or any symptoms attributed to the diverticulum for 1 year after surgery. We herein present a rare case of portal vein thrombosis associated with colonic diverticulitis, for which there are limited reports of conservative treatment followed by elective surgery.</p>

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