Though parastomal abscess from an impacted chicken bone has been previously reported,4
it is the first reported case of organised parastomal abscess from a mesocolic diverticulum. Low-grade infection in an immunosuppressed patient with compromised renal function may give rise to dehydration, poor oral intake and constipation. This, with a parastomal swelling, gave the impression of an obstructed parastomal hernia as the incidence rate of parastomal hernia is as high as 33%.5
The organised mesocolic abscess was detected by a subsequent CT scan. Justifiably, CT scan remains the ‘gold standard’ investigation for suspected diverticular abscess.2
Ambrosetti et al
states that mesocolic abscesses can usually be managed conservatively without drainage and, should surgery be necessary, en bloc resection with immediate anastomosis can usually be performed.6
This was not a valid option in the above case for obvious comorbidities and technical difficulties. Since the original communication between the diverticular abscess and the lumen of the bowel is obliterated,3
percutaneous drainage can safely be performed in patients with a diverticular abscess under radiological guidance. It can be used as a bridge before definitive surgery but it is a treatment option in its own right in high-risk surgical patients,7
such as this case. Successful percutaneous drainage can be performed in 70–90% of patients with an amenable diverticular abscess.7
- Parastomal abscess from mesocolic diverticulum in an immunocompromised patient is a possibility and might present as an incarcerated parastomal hernia.
- Careful clinical assessment and subsequent investigations are absolutely imperative in such situation.
- CT-guided drainage helped to avoid surgical intervention in this high risk patient.