A Case Report of Subacute Combined Degeneration induced by the Operation for Mesenteric Abscess Formation due to Penetration of one of the Multiple Diverticula of the Small Bowel

Masaoki Hattori, Hideaki Suzuki, Hiroaki Shibahara, Shingo Kuze and Jyunichi Takamizawa

Department of Surgery, Fukuroi Municipal Hospital

A 55-year-old woman was admitted for lower abdominal pain was found in abdominal ultrasonography and computed tomography to have abscess in the pelvic space. Laparotomy showed a mesenteric abscess formed due to penetration of the ileal diverticulum and multiple large diverticula of the small bowel, necessitating partial resection of 25 cm of the small intestine. She had an uneventful postoperative course and was discharged, returning three months later reporting rapidly progressive gait disturbance and numbness in the distal limbs. Her serum vitamin B12 was low at 68 pg/ml. Magnetic resonance imaging of the spinal cord showed hyperintensity in the posterior column below the thoracic cord. Under a diagnosis of subacute combined degeneration due to vitamin B12 deficiency, we undertook intravenous injection of mecobalamin. Her muscle strength and sensory impairment improved progressively and she became able to walk. Early onset of SCD after resection of a short segment of small intestine indicated that preoperative deficient vitamin B12 was due to many large intestinal diverticuli. Patient having multiple diverticuli of the small intestine, and undergoing laparotomy with fasting should thus be evaluated for vitamin B12 deficiency.

Key words
multiple diverticula of small intestine, mesenteric abscess, subacute combined degeneration

Reprint requests
Masaoki Hattori Department of Surgery, Fukuroi Municipal Hospital
2515-1 Kunou, Fukuroi, 437-0061 JAPAN

Accepted
July 25, 2007

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