Hesketh Richard L, Fong Michelle, Shepherd Sophie, Kalidindi Venugopala
Department of Radiology, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK.
Department of Clinical Radiology, University College London Hospital, 235 Euston Road, London, NW12BU, UK.
Radiol Case Rep. 2021 Jun 8;16(8):1961-1964. doi: 10.1016/j.radcr.2021.04.075. eCollection 2021 Aug.
Diverticulitis is a common cause of an acute surgical abdomen and computed tomography has become an essential part of work up particularly to identify complications that commonly include intraperitoneal perforation, abscess and fistula formation. We report the case of an 81-year-old male who presented to the emergency department with acute lower abdominal pain and was found to have sigmoid diverticulitis with the rare complications of a diverticular abscess that had formed a sinus tract and perforated into the retroperitoneum and secondary acute appendicitis. Initial management was with intravenous antibiotics, a Hartmann's procedure and appendicectomy. Subsequently the retroperitoneal collection was drained percutaneously. The case was further complicated by the patient's multiple co-morbidities and unfortunately the patient died 6 weeks after admission from sepsis. This case highlights the role of computed tomography in the pre- and post-operative period to identify complications which are often clinically occult and require early surgical and interventional radiology management to optimize outcomes.
憩室炎是急性外科急腹症的常见病因，计算机断层扫描已成为检查的重要组成部分，特别是用于识别常见的并发症，这些并发症通常包括腹腔内穿孔、脓肿和瘘管形成。我们报告一例81岁男性病例，该患者因急性下腹痛就诊于急诊科，经检查发现患有乙状结肠憩室炎，并伴有罕见的并发症，即憩室脓肿形成窦道并穿入腹膜后，继发急性阑尾炎。初始治疗采用静脉抗生素、Hartmann手术和阑尾切除术。随后经皮引流腹膜后积液。该病例因患者多种合并症而进一步复杂化，不幸的是，患者在入院6周后因败血症死亡。该病例突出了计算机断层扫描在术前和术后阶段的作用，以识别那些临床上常隐匿且需要早期手术和介入放射学管理以优化治疗结果的并发症。
