1Department of Gastroenterology, Nishi-Kobe Medical Center, 2Department of Clinical Laboratory, Nishi-Kobe Medical Center, 3Department of Surgery, Nishi-Kobe Medical Center, 4Department of Pathology, Nishi-Kobe Medical Center
small intestinal diverticulosis, intestinal perforation, terminal ileum, ultrasonography
We report a case of small intestinal diverticulitis diagnosed with abdominal ultrasonography. A 79-year-old man presented with right lower quadrant abdominal pain and fever. Because the physical examination showed tenderness and muscular guarding, we suspected local peritonitis due to acute appendicitis or diverticulitis of the ascending colon. However, ultrasonography and CT scan showed severer inflammatory change not in the ileocecal region. There was also no sign of local peritonitis caused by perforation of acute appendicitis. There was a mass lesion in the terminal ileum, 10 cm proximal to the ileocecal valve, which was found to be a mesenteric abscess secondary to perforation of the terminal ileum. The pathological diagnosis of this case was mesenteric abscess caused by a penetrated diverticulum of the terminal ileum. Ultrasonography was very useful in the preoperative diagnosis.