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An unexpected cause of persistent bacteraemia and portomesenteric venous gas

Journal Volume 84 - 2021
Issue Fasc.2 - Case reports
Author(s) A. Loobuyck 1, G. Vermeersch 2, M. D’Hondt 3, T. Billiet 4
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Full Article
PAGES 375-377
(1) Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium & Department of Internal Medicine, AZ Groeninge, Kortrijk, Belgium
(2) Faculty of Medicine and Health Sciences, Catholic University of Leuven, Leuven, Belgium & Clinical Internship at the Department of Internal Medicine, AZ Groeninge, Kortrijk, Belgium
(3) Department of Abdominal Surgery, AZ Groeninge, Kortrijk, Belgium
(4) Department of Gastroenterology and Hepatology, AZ Groeninge, Kortrijk, Belgium

We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis with an unusual evolution. The patient initially presented with classic symptoms of lower abdominal pain and fever. Diagnosis of uncomplicated sigmoid diverticulitis was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures were positive for omnisensitive Escherichia Coli, but despite adequate intravenous antibiotic therapy, episodes of bacteraemia persisted and hemocultures remained positive. Repeat CT scan demonstrated regression of inflammation without signs of abcedation or perforation consistent with clinical findings. Endocarditis was excluded with a normal transoesophageal echocardiography. Finally, positron emission tomography-computed tomography (PET-CT) suspected a colovenous fistula and the presence of PMVG. The patient was successfully treated with laparoscopic sigmoidectomy. This case report summarises the diagnostic pathway and aims for higher awareness of non-ischemic PMVG causes.

Keywords: Diverticulitis, fistulization, portomesenteric venous gas.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.