A Case of Pericecal Abscess that Treated Endoscopically, Followed by Surgical Resection

Shuichiro Uchiyama¹⁾³⁾, Kenji Toyonaga¹⁾³⁾, Masahide Hiyoshi²⁾³⁾ and Kazuo Chijiiwa³⁾

Department of Surgery, Miyakonojo Medical Association Hospital¹⁾
Department of Surgery, Miyakonojo National Hospical²⁾
Department of Surgery 1, Faculty of Medicine, University of Miyazaki³⁾

We report a case of a pericecal abscess that was treated endoscopically, followed by surgical resection. A 52-year-old man was admitted to our hospital with complaints of right lower abdominal pain and fever which was lasted for two weeks. Abdominal computed tomography (CT) revealed the presence of an ileocecal mass lesion, 4 cm in diameter, and diverticulosis. The lesion was diagnosed as a pericecal abscess secondary to diverticulitis. Although the symptoms improved with the conservative therapy, the ileocecal mass was still present on CT and Barium enema imaging. Colonoscopy showed a tumor-like protrusion with redness at the cecum, and a biopsy was performed resulting in the discharge of whitish pus. After the biopsy, the tumorous mass was reduced, and the lesion appeared to be cured. However, recurrence of inflammation was observed seven months later, and conservative therapy had no effect, so ileocecal resection was undertaken. The resected specimen showed a pericecal abscess due to the diverticulitis. Among eleven cases of pericecal abscess reported so far, in which pus discharge was observed endoscopically, there was no case that showed recurrence of inflammation after the endoscopic treatment. This case suggests that careful follow-up is still required taking into consideration the recurrence of inflammation after the therapeutic endoscopic discharge of the absess component.

Key words
pericecal abscess, endoscopic drainage, diverticulitis

Reprint requests
Shuichiro Uchiyama Department of Surgery 1, Miyazaki Medical College, Faculty of Medicine, University of Miyazaki
5200 Kihara, Kiyotake, Miyazaki-gun, 889-1692 JAPAN

Accepted
April 27, 2005

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