A perforated diverticulum in the terminal ileum

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 6; pp. 1411 - 1415
• Main Authors: ANDOH, Tatsumasa, ENOKIDA, Yasuaki, OGAWA, Tetsushi, ITOU, Hideaki, TOMIZAWA, Naoki, TAKEYOSHI, Izumi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2012
• Subjects: diagnostic laparoscopy; perforation; pseudo–diverticulum of the small intestine
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.1411

We report a patient with a perforated pseudo-diverticulum in the terminal ileum, diagnosed at laparoscopy. A 75-year-old man was admitted to hospital with lower abdominal pain of 2 days duration. A physical examination revealed tenderness and muscle guarding in the middle lower half of the abdomen. Enhanced abdominal computed tomography (CT) showed edematous changes in the ileocecal region and a small amount of ascites in the pouch of Douglas, but no free air. Panperitonitis was diagnosed, and diagnostic laparoscopy was performed. Laparoscopy showed dirty ascites and a perforated terminal ileum on the side opposite the mesentery. The laparoscopy was converted to a laparotomy, and an ileocecal resection and intra-abdominal drainage were performed. On histopathology, a small intestinal pseudo-diverticulum with perforation was diagnosed. The postoperative course was uneventful, and the patient was discharged on 7th postoperative day.