An unexpected cause of persistent bacteraemia and portomesenteric venous gas

We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis an unusual evolution. The patient initially presented classic symptoms lower abdominal pain and fever. Diagnosis uncomplicated was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures positive omnisensitive Escherichia Coli, but despite adequate antibiotic therapy, episodes bacteraemia persisted hemocultures remained positive. Repeat CT scan demonstrated regression inflammation without signs abcedation or perforation consistent clinical findings. Endocarditis excluded normal transoesophageal echocardiography. Finally, positron emission tomography-computed (PET-CT) suspected colovenous fistula presence PMVG. successfully treated laparoscopic sigmoidectomy. This summarises diagnostic pathway aims higher awareness non-ischemic PMVG causes.