Clinical signs of retroperitoneal abscess from colonic perforation

Abstract

Rationale:Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs.Patients’ concerns:A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.Diagnosis:In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection.Interventions:In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess.Outcomes:The first patient underwent right colectomy with ileostomy in the 7th postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive.Lessons:The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

“…It is the third most common cancer in the world with the second highest mortality rate. In 2018, it is estimated that about 1,800,977 people worldwide will develop the disease, of which about 861,663 will die [2]. Various prognostic factors influence the survival outcomes of colorectal cancer patients.…”

“…For elderly colorectal cancer patients, the probability of death from non-tumor factors, such as cardiovascular and cerebrovascular accidents, severe infections, and underlying diseases, is higher than that of average population, which will hinder the occurrence of death caused by tumor factors. In the case of colon cancer, elderly patients are more likely to develop very rare retroperitoneal colonic perforations and eventually die of severe infection [2]. Therefore, it becomes more difficult for clinicians to predict the prognosis accurately.…”

Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature

“…A retroperitoneal abscess is a relatively uncommon clinical disease, the main causes of which are pancreatitis, appendicitis, perforations of the colon and rectum [ 6 ], and complications after surgery [ 7 ]. Duodenal perforation is also a relatively uncommon disease usually caused by diverticulum, infectious diseases (such as H. pylori infection), Crohn’s disease, enteritis caused by drugs or radiation, foreign bodies (such as fish bones), and trauma [ 2 – 4 ].…”

Fecal Scrotal Abscess Secondary to Spontaneous Retroperitoneal Perforation of Ascending Colon

“…Spontaneous perforation of the colon (SPC) is rare [ 2 , 3 ] and is defined as perforation of a normal colon without any contributing factor such as disease of the bowel or hernia [ 3 ]. The retroperitoneal colonic perforations are rare causes of a retroperitoneal abscess and are exclusively seen in frail elderly patients [ 4 ]. No case of spontaneous retroperitoneal perforation of ascending colon causing an abscess or enterocutaneous fistula of the scrotum in the absence of hernia has been ever reported to the best of our knowledge in indexed literature.…”