Snapshot in surgery: brain abscess as a complication of a recurrent sigmoid diverticular abscess Zhaowei Zhou1, Siddhartha Wuppalapati2 & Nigel Scott1 1
Department of Colorectal Surgery, Royal Preston Hospital, Preston, UK Department of Neuroradiology, Royal Preston Hospital, Preston, UK
Correspondence Mr Zhaowei Zhou, Department of Colorectal Surgery, Royal Preston Hospital, Sharoe Green Lane north, Fulwood, Preston, Lancashire PR2 9HT, UK. Tel: +0044(0) 1772 522261; Fax: +0044(0)1772522875; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
A 35-year-old man was found to have a cerebral abscess secondary to a recurrent sigmoid diverticular abscess. Both cultures grew Streptococcus anginosus. Brain abscess is a rare but potential complication of sigmoid diverticulitis. Streptococcus anginosus, which is found in human gut flora, is a common cause of brain abscess.
Brain abscess, diverticular abscess, sigmoid diverticulitis, Streptococcus anginosus.
Received: 10 November 2014; Accepted: 3 March 2015 Clinical Case Reports 2015; 3(6): 506–507 doi: 10.1002/ccr3.272
Snapshot quiz What do these images show and how should it be treated? Figure 1: Axial image of MRI brain (FLAIR sequence)
Figure 2: Axial image of CT brain angiogram
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Z. Zhou et al.
Figure 3: Sagittal image of CT abdomen and pelvis
Brain abscess in diverticular disease
Answer: A 35-year-old man presented with one day history of dysarthria, dysphagia, and right temporal headache. He had a percutaneous drainage and antibiotic treatment of a sigmoid diverticular abscess 7 months previously. MRI brain showed a right posterior frontal motor cortex lesion (yellow arrow) which was initially diagnosed as glioma. A CT angiogram was then performed, but showed no vascular abnormality in relation to this lesion (red arrow). The images were subsequently discussed in the Neurosurgical MDT. A brain abscess with cerebritis and cerebral edema was diagnosed. A CT scan of abdomen and pelvis later showed an abscess formation (blue arrow) in the anterior pelvis which was closely related to the bladder doom and the distal sigmoid colon. The patient underwent a right frontoparietal mini-craniectomy and evacuation of cerebral abscess, followed by Hartmann’s procedure. The abscess cultures both grew Streptococcus anginosus. He made a full neurological recovery and was discharged with outpatient parenteral antibiotic therapy.
Conflict of Interest None declared.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.