CASE REPORT
An 86 years old woman, with history of hypertension, diabetes and
dyslipidaemia, was
operated for acute appendicitis confirmed by abdominal ultra-sound.
Intraoperative
exploration (through a McBurney incision) revealed a gangrenous appendix
with oedematous
and slightly cyanotic ileo-caecal junction. The unusual aspect of the
latter was assigned to local inflammation and usual appendectomy was
performed. Three days later, she presented
dyspnea and hypoxemia. Abdomino-thoracic angioscan showed a proximal
pulmonary
embolism with a circumferential thickening of the caecum and terminal
ileum without any
local collection. Heparin therapy was started and antibiotics were
prescribed. Seven days later, she had a new abdominal scan because of
abdominal distension with diffuse abdominal
tenderness, fever and hyper leucocytosis. It suggested a mesenteric
venous infarction as it
showed superior mesenteric vein thrombosis (Figures 1 and 2) associated
to circumferential
thickening and default enhancement of the caecum and terminal ileum
(Figure 1). The patient
had a respiratory failure and died before we could perform intestinal
resection.