Thigh abscess following acute diverticulitis. Report of two cases

Abstract

SUMMARY
The incidence of inflammatory diverticular disease in
patients with diverticulosis has been reported to range from
12%-35%. Delayed diagnosis and treatment of perforated
diverticulitis is accompanied by high mortality. Perforation
of diverticulum is often localized and may result in abscess
formation. This abscess may resolve, may rupture into the
peritoneal cavity or may drain into various organs or viscera.
Finally, the abscess may track intraperitoneally or extraperitoneally.
In both cases presented here, there was a communication
of the inflammatory divericular disease of the sigmoid colon
with an abscess cavity in the Scarpa’s triangle, tracking
down through the femoral canal in the first case, and
through the abdominal wall in the second case. The underlying
intraabdominal lesion was treated by sigmoidectomy
according to Hartmann’s procedure in the first case and by
sigmoidectomy and an end- to- end anastomosis in the
second. These procedures were combined with local
drainage of the thigh abscesses with good results.
In conclusion, it becomes apparent that in such cases, where
the underlying intraabdominal lesion is overlooked, the
mortality rate is as high as 93%. However, if the underlying
intraperitoneal pathology is early recognised and successfully
treated, in combination with thigh abscess management,
the overall mortality drops to 34%.
Key Words: thigh abscess, acute diverticulitis, management