Pneumopylephlebitis and intramesocolic diverticular perforation.

The insidious presentation of intramesocolic perforation in diverticulitis has been reviewed, and two cases of intramesocolic perforation associated with pneumopylephlebitis have been reported. Review of the two previously reported cases of pneumopylephlebitis associated with diverticular perforation suggests that these may have been intramesocolic perforations as well. Exploratory laparotomy is clearly indicated in cases of pneumopylephlebitis. In patients with recurrent sepsis without a probable source, a water-soluble contrast enema is recommended. If conservative measures fail, an exploratory laparotomy should be performed to exclude intramesocolic abscess.