A 82-year-old man was admitted to our hospital with a 7-day history of fever of unknown origin. He had a history of colonic diverticulitis but no other infective hotbeds were found.
Gastrointestinal investigations were inconclusive. A virtual colonoscopy was asked in order to discover a possible cause of fever as patient could not perform the optical one because he had a very low FE and he was having oral anti-coagulant therapy.
In order to obtain a suitable bowel cleaning, patient was asked to follow a low dross content diet during the three days before the examination; the morning of the CTC, patient was asked to drink about 200 mL of dimeglumine diatrizoate (Gastrografin, Bayer-Schering) in order to tag both feces and fluid remains.
A previous basal CT scan was obtained in order to exclude the presence of radiological sings of an active diverticulitis which is a contraindication to CTC because at risk for colonic perforation. CTC, performed after gently colonic room air distension, showed the presence of many diverticula spread on the whole colon, especially at the level of sigma, without any lumen stenosis, any evidence of masses or polyps. As extracolonic findings, it was reported the appearance of gas in mesenteric vein (Figures 1(a) and 1(b)) and within the portal venous system, involving both hepatic lobes (Figure 2).
There was no evidence of pneumatosis intestinalis or colonic perforation or free fluid in the abdomen.
Then, a CT scan without enema was required after 24 hours in absence of worsened patient conditions.
During the night patient only complained for slight abdominal pain but his conditions remained stable.
The CT scan performed after 24 hours revealed the disappearance of gas in mesenteric vein and portal venous system (Figure 3).