Diverticulitis of multiple diverticulosis of the terminal ileum.

Diverticulosis of the terminal ileum is very rare. We report a case of diverticulitis of multiple diverticula of the terminal ileum. A 67-year-old Japanese woman consulted to our hospital because of abdominal pain and melena. A blood laboratory revealed severe anemia increased CRP (11.21 mg/dl). The upper and lower gastrointestinal endoscopic examination revealed no significant changes. The colon was free from diverticulum. CT demonstrated two tumors in the small intestine. PET identified a few shadows identical to the tumors detected by CT. The clinical diagnosis was small intestinal tumors, particularly malignant lymphoma. Operation was performed, and it revealed multiple tumor-like masses in the terminal ileum. The ulcers are deep and appeared diverticula. Microscopically, the diverticula were located in the proper muscle and subserosa. The walls of the diverticula were composed of granulation tissue with heavy lymphocytic and neutrophilic infiltration. Diverticular mucosal walls were recognized in some areas. The lymphocytes were free from atypia, and no features of malignant lymphoma were recognized. The pathological diagnosis was severe diverticulitis of multiple diverticula in the terminal ileum.