A 71-year-old woman with a history of arterial hypertension, kidney transplants without associated colitis, came to the emergency department because she presented with a 24-hour history of fever, more intense abdominal pain in the left iliac fossa, and vomiting.
On physical examination, the patient had a low-grade fever, was hemodynamically stable, well hydrated, eupneic and normocolored.
The abdomen was blandom and depressible, with pain to severe constipation, without clear focalization and without signs of peritoneal irritation.
As complementary tests, laboratory tests showed mild leukocytosis (10,200/μl) with a CRP of 2 mg/dl, neutrophilia, and a simple abdominal X-ray that was normal.
The diagnostic suspicion of acute inflammatory diverticula was established by abdominal computed tomography, which revealed a diverticulum in the small intestine, a diverticulum with a high morphology and a 16 mm internal bone with signs suggestive of an internal diverticulum.
A millimetric pneumoperitoneum bubble and inflammation of the adjacent fat were also observed adjacent to the diverticulum. These findings were compatible with acute diverticulum diverticulum with a foreign body.
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With these results and given the acceptable general status of the patient, she was admitted to the hospital for treatment with digestive rest, broad-spectrum intravenous antibiotic therapy (Imipenem 500 mg every 6 hours) and observation.
During the stay the patient improves the fever but the abdominal pain persists, so a scheduled surgical intervention was decided.
During the intervention, multiple diverticula were evident at the level of the Andean, one of them with inflammatory signs, but without intra-abdominal abscesses.
The gallbladder is distended and the choledochus duct shows a larger diameter 1 cm. Intestinal resection was performed with reconstruction by side anastomosis, bile duct after cholecystography cholelithiasis was confirmed by Keterolithiasis removal.
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The immediate postoperative period was uneventful, reintroducing the diet with good tolerance and digestive tract.
A trans-Kehr cholangiography was performed, which showed absence of coccidioidomycosis.
On the tenth postoperative day, the patient developed sudden abdominal pain, associated with hypotension and elevation of pancreatic enzymes, and was admitted to the ICU with a diagnosis of moderate acute pancreatitis.
