Inferior mesenteric vein pylephlebitis due to sigmoid diverticulitis

Description

A 55-year-old man was admitted to the emergency department, with high fever. Physical examination revealed a soft abdomen without any signs of peritoneal irritation and bowel sounds were normal. Laboratory tests revealed elevation of white cell count (11.5x10³/mm³) and C reactive protein. Contrast-enhanced CT showed sigmoid colon diverticulosis and increasing stranding of fat tissue adjacent to the sigmoid colon, in keeping with diverticulitis (figure 1). In addition, complete thrombosis of the inferior mesenteric vein (IMV) with intraluminal filling defect, perivenous inflammatory changes and subtle enhancement of the venous wall were identified (figure 2). There was no involvement of splenic and superior mesenteric veins, and intraluminal air was not present. A Gram stain of the patient's blood revealed the presence of Gram-negative bacilli. He was discharged and followed up on antibiotics and anticoagulation therapy.

Figure 1

Contrast-enhanced axial CT image demonstrating multiple diverticula...

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