case_images: PMC7609150_01
case_images: Case 1 findings. (a) Contrast-enhanced CT revealed the inflammation of mesenterium caused by penetration of a terminal ileac 2-cm diverticulitis (arrow). The CT detected air in the terminal ileum's mesentery. However, no free air was detected in the abdominal cavity. (b) Resected specimen postileocecal resection revealed at least two diverticulum. Two surgical bougie probes show diverticulum of specimens. (c) Specimen cross section of penetration from diverticulitis (arrow). (d) Histological (H&E) evaluation of the diverticulum mucosa. Inflammatory granuloma (arrowheads) was observed in the diverticulitis (arrow). An additional diverticulum was detected (asterisk). (e) Histologically (H&E), we observed severe inflammatory findings (arrowheads).
case_images: CRIS2020-7361389.001.jpg
case_images: PMC7609150_01_CRIS2020-7361389.001.jpg
case_images: fig1
case_images: Additionally, the CT detected air in the terminal ileum's mesentery, whereas no free air was found in the abdominal cavity (Figure 1(a)). Two diverticulum at the terminal ileum were detected, along with inflammatory thickening of the mesentery (Figures 1(b) and 1(c)). Additionally, it found two in five points of terminal ileum diverticulum perforation (Figures 1(d) and 1(e)).
case_images: PMC7609150_02
case_images: Case 2 findings. (a) CT scan showed penetration of terminal ileum diverticulitis and air (white arrow) in the near mesentery. (b) Resected specimen after ileocecal resection showed the presence of diverticulum. The dotted line represents the cross section line for Figure 2(c). (c) Specimen cross section of penetration from diverticulitis (asterisk). (d) Microscopic feature (H&E). Inflammation due to diverticulitis is observed in the area enclosed by the dotted square. (e) Microscopic examination (H&E) of the tissue within the dotted square from Figure 2(d). An area of inflammation was observed in the intestinal mucosa (arrow) with diverticulitis.
case_images: CRIS2020-7361389.002.jpg
case_images: PMC7609150_02_CRIS2020-7361389.002.jpg
case_images: fig2
case_images: CRP of 8.82 mg/dL. CT showed penetration of terminal ileum diverticulitis and air in the near mesentery (Figure 2(a)). The patient was surgically treated with an ileocecal resection 2 days postadmission (Figures 2(b) and 2(c)). Pathological examination revealed that the diverticulum was a false diverticulum and penetrated terminal ileum diverticulum (Figures 2(d) and 2(e)).
case_images: PMC7609150_03
case_images: Case 3 findings. (a) CT showed abscess formation by penetration of terminal ileum diverticulitis (arrowheads) into the psoas muscle (P) and retroperitoneum. (b) Resected specimen after ileocecal resection showed the presence of diverticulum. The dotted line represents the cross section line for Figure 3(c). (c, d) Specimen cross section and microscopic examination (H&E) shows terminal ileum diverticulum (asterisk), intestinal mucosa (arrow), inflammation area, and intestinal mucosa (arrowheads), and fibrosis area (F).
case_images: CRIS2020-7361389.003.jpg
case_images: PMC7609150_03_CRIS2020-7361389.003.jpg
case_images: fig3
case_images: CRP of 10.05 mg/dL. CT showed penetration of the terminal ileum diverticulitis and an abscess from the terminal ileum through the psoas muscle until the inguinal area (Figure 3(a)). Laparoscopic ileocecal resection was performed 30 days postadmission (Figures 3(b) and 3(c)). Histopathological results revealed that the diverticulum was a false diverticulum and showed penetrated terminal ileum diverticulum (Figure 3(d)).
case_images: PMC7609150_04
case_images: Case 4 findings. (a) CT showed abscess formation by penetration of terminal ileum diverticulitis (arrowheads). (b) Fluoroscopy examination showed the abscess puncture and drainage using 7Fr PTC Drainage tube (Pigtail type, CREATE MEDIC CO., LTD., Japan) were performed. At this time, the ileum and cecum were not visualized. (c) Fluoroscopy examination showed the presence of guidewire and drainage tube inside the cecum through the terminal ileum after 5 days of drainage. (d) Fistography examination using a drainage tube did not show terminal ileum after 13 days.
case_images: CRIS2020-7361389.004.jpg
case_images: PMC7609150_04_CRIS2020-7361389.004.jpg
case_images: fig4
case_images: CRP of 22.01 mg/dL. CT showed a 5 cm abscess of the pericecal area (Figure 4(a)). Drainage tube (Pigtail type, CREATE MEDIC CO., LTD., Japan) were performed (Figure 4(b)). Drainage tube existed within the cecum through the terminal ileum after 5 days of drainage (Figure 4(c)). The drainage catheter was changed into a 10Fr PTC Drainage tube (Straight type, CREATE MEDIC CO., LTD., Japan) (Figure 4(c)). Fistography examination using the drainage tube did not show the terminal ileum after 13 days (Figure 4(d)).