P0294 - A Rare Case of Cecal and Ascending Colon Diverticulitis With Ileocolic Vein Thrombophlebitis

Bala Sai Teja Nuthalapati, MBBS¹, Srinivasulu Dudyala, MBBS, MD, DM², Pratyush Sachdeva, ³, Goutham Reddy Anugu, MBBS⁴, Saikumar Kokkula, MBBS⁵, Pelash Kumar, ⁶, Sweta Sahu, MBBS⁷, Amukta Palakurthi, ⁸, Aastha Naik, ^9
1Maheshwara Medical College, Hyderabad, Telangana, India; ²Sri Sri Holistic Hospitals, Hyderabad, Telangana, India; ³Punjab Institute of Medical Sciences, Vizag, Andhra Pradesh, India; ⁴Osmania Medical College, Nalgonda, Telangana, India; ⁵Guntur Medical College, Guntur, Andhra Pradesh, India; ⁶Liaquat University of Medical and Health Science, Vizag, Andhra Pradesh, India; ⁷JJM Medical College, Devanagere, Karnataka, India; ⁸Osmania General Hospital and Medical College, Visakhapatnam, Andhra Pradesh, India; ⁹Parul Institute of Medical Sciences, Vizag, Andhra Pradesh, India

Introduction: Focal inflammation and resultant micro-perforations constitute diverticulitis. Right sided diverticulitis is an uncommon occurrence. Additionally Pylephlebitis, or ascending septic thrombophlebitis, is a dangerous and rare compilation of abdominal inflammatory processes associated with diverticulitis.

Case Description/Methods: A 61 year old male presented to the emergency department with intermittent fever associated with chills, multiple episodes of vomiting, loss of appetite, loose stool, abdominal bloating, and burning micturition for ten days. He reported sticky, foul smelling stools and was passing flatus on presentation. He was a known smoker and alcoholic for 40 years but quit 3 years ago. On examination, he was febrile with abdominal tenderness in the right lower quadrant region. Blood parameters showed normocytic anemia with lymphopenia, agranulocytosis and high ESR, high CRP and a mild increase in PT/INR. A complete urine examination revealed the presence of protein, blood and plenty of pus cells /HPF. In addition, all viral markers were non-reactive.The CECT abdomen revealed multiple small, inflamed diverticula in the walls of the cecum and ascending colon, with mild mesenteric fat stranding along the anteromedial aspect of the cecum and right ileocolic junction. A complete and partial thrombus is noted in the ileocolic vein and superior mesenteric vein, respectively, with small air pockets, filling defects, and there is adjacent fat stranding. The patient was started on intravenous CEFOPERAZONE/SULBACTAM 1.5 g for 2 days, injection MEROPENEM 1 g IV for 2 days, and he was also given intravenous Ondansetron, Paracetamol, and Pantoprazole for 4 days. The patient was resolved of his symptoms on day 5 and was discharged with normal blood parameters.

Discussion: Right colon diverticulitis accounts for 1-3.6% of instances of diverticular illnesses, with ileocecal vein thrombophlebitis presenting as an unusual cause of lower quadrant pain. It is challenging to differentiate its mimicry from acute appendicitis with a 2-3 days history of gastrointestinal symptoms, predominantly with a 3:2 M:F ratio and a median age of 44 years. Our case demonstrates that a high index of clinical suspicion, with the implication of correct imaging techniques such as CT depicting filling defects in the vein with an intraluminal thrombus, is therefore essential for prompt diagnosis.



Disclosures:


Bala Sai Teja Nuthalapati, MBBS¹, Srinivasulu Dudyala, MBBS, MD, DM², Pratyush Sachdeva, ³, Goutham Reddy Anugu, MBBS⁴, Saikumar Kokkula, MBBS⁵, Pelash Kumar, ⁶, Sweta Sahu, MBBS⁷, Amukta Palakurthi, ⁸, Aastha Naik, ⁹. P0294 - A Rare Case of Cecal and Ascending Colon Diverticulitis With Ileocolic Vein Thrombophlebitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.