Journal List > J Korean Soc Radiol > v.69(1) > 1087348

TOOLS
Cha, Lee, Yi, Lee, and Hong: Septic Thrombophlebitis of the Inferior Mesenteric Vein and Associated Mesenteric Abscess Complicating Sigmoid Diverticulitis: A Case Report
Abdominal Radiology

Journal of the Korean Society of Radiology 2013; 69(1): 67-70.

Published online: 12 July 2013

DOI: https://doi.org/10.3348/jksr.2013.69.1.67

Septic Thrombophlebitis of the Inferior Mesenteric Vein and Associated Mesenteric Abscess Complicating Sigmoid Diverticulitis: A Case Report

Seongjae Cha, MD, Hae-Kyung Lee, MD, Beom Ha Yi, MD, Min Hee Lee, MD, Hyun-Sook Hong, MD

Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Corresponding author: Hae-Kyung Lee, MD. Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea. Tel. 82-32-621-5851, Fax. 82-32-621-5874, hklee@schmc.ac.kr

Received 30 January 2013       Accepted 30 April 2013

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thrombophlebitis occurs secondarily to inflammatory conditions of adjacent organs, and radiologic finding is essential for diagnosis. However, because of the rarity on clinical cases that involve the inferior mesenteric vein, many radiologists are unfamililiar with its location and appearance. We experience a case of septic thrombophlebitis with abscess complication sigmoid diverticulitis. CT scans reveals a low density thrombus and air in the inferior mesenteric vein, combining with perivascular fat infiltration, and focal wall defects with abscess formation. After surgical treatment, the abscess was not visible in the follow-up CT scans. Septic thrombophlebitis of the inferior mesenteric vein, although being a rare disease, should be diagnosed on CT according to the given unique location, the appearance of inflamed vein and the adjacent descending mesocolon.

Keywords: Thrombophlebitis, Abscess, Diverticulitis, CT

Figures and Tables

Fig. 1
A 72-year-old man with septic thrombophlebitis of the inferior mesenteric vein complicating sigmoid diverticulitis.
A-D. Axial contrast-enhanced CT scans of the abdomen and pelvis show air (thick arrow) in the splenic vein (A) and low-attenuation thrombus (thin arrow) in the inferior mesenteric vein (B) which is maximally dilated at the level of the renal hilum. Mesenteric abscess (open arrow) filled with pus and air (C) is connected with focal wall defect (arrowhead) of the thrombosed inferior mesenteric vein (B). Sigmoid colon (D) shows multiple diverticula with inflamed diverticulum and pericolic fat infiltration, representing sigmoid diverticulitis.
E. Coronal reformatted image shows the dilated, thrombused inferior mesenteric vein with focal perforation (arrowhead).
jksr-69-67-g001

References

1. Lim HE, Cheong HJ, Woo HJ, Kim WJ, Kim MJ, Lee CH, et al. Pylephlebitis associated with appendicitis. Korean J Intern Med. 1999; 14:73–76.
2. Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis. 1995; 21:1114–1120.
3. Charnsangavej C, DuBrow RA, Varma DG, Herron DH, Robinson TJ, Whitley NO. CT of the mesocolon. Part 1. Anatomic considerations. Radiographics. 1993; 13:1035–1045.
4. Charnsangavej C, Dubrow RA, Varma DG, Herron DH, Robinson TJ, Whitley NO. CT of the mesocolon. Part 2. Pathologic considerations. Radiographics. 1993; 13:1309–1322.
5. Molitch HI. Septic thrombophlebitis of the inferior mesenteric vein complicating sigmoid diverticulitis: CT findings. AJR Am J Roentgenol. 1996; 167:1014–1016.
6. Lee L, Kang YS, Astromoff N. Septic thrombophlebitis of the inferior mesenteric vein associated with diverticulitis CT diagnosis. Clin Imaging. 1996; 20:115–117.
7. Lee IK, Kim SA, Lee YS, Oh ST, Jeon HM, Kim EK, et al. Thrombophlebitis of the inferior mesenteric vein. J Korean Soc Coloproctol. 2005; 21:329–332.
8. Balthazar EJ, Gollapudi P. Septic thrombophlebitis of the mesenteric and portal veins: CT imaging. J Comput Assist Tomogr. 2000; 24:755–760.
9. Chang YS, Min SY, Joo SH, Lee SH. Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis. World J Gastroenterol. 2008; 14:4580–4582.
10. Nobili C, Uggeri F, Romano F, Degrate L, Caprotti R, Perego P, et al. Pylephlebitis and mesenteric thrombophlebitis in sigmoid diverticulitis: medical approach, delayed surgery. Dig Liver Dis. 2007; 39:1088–1090.
TOOLS
Similar articles