WTP3.12 Pneumatosis of the Gonadal Vessels with Septicaemia: Optimising Patient Outcomes

Abstract Aims To discuss a rare case of pneumatosis of the gonadal vessels associated with sepsis secondary to sigmoid diverticular perforation, highlighting the importance of multidisciplinary collaboration in improving patient outcomes. Methods A 60-year-old patient presented with a two-week history of abdominal pain, nausea, systemic illness and prior constipation. A colonoscopy several weeks prior to this was normal. Examination revealed lower-right abdominal tenderness, raised inflammatory markers and borderline high lactate. Initial management included resuscitation and sepsis protocol initiation. CT abdomen and pelvis with contrast (images) revealed perforated sigmoid diverticulitis, an abscess on the right broad ligament and pneumatosis in the right ovarian vein extending to the inferior vena cava (IVC) but sparing the IVC itself. Results An emergency multidisciplinary team (MDT) of surgeons, radiologists, gynaecologists and urologists determined optimal management. Bilateral ureteric stenting preceded an emergency laparotomy. Intraoperatively, a Hartmann's procedure and successful abscess drainage were performed. Postoperatively, the patient made a good recovery, with ureteric stents removed prior to discharge. Conclusions This case underscores the critical role of virtual or in-person emergency MDT in managing complex presentations, enabling swift decision-making and improved surgical planning. Pneumatosis of the ovarian vein associated with sigmoid perforation represents a rare phenomenon, not previously reported. There is no valve in the ovarian vein allowing unidirectional flow of blood into the IVC. This is critical as prompt source control was needed to stop systemic pneumatosis via IVC and spread of sepsis. Lessons from this case may inform the management of similarly complex presentations in the future.