Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Montori, Giulia; Giovanni, Giacomo Di; Mzoughi, Zeineb; Angot, Cedric; Samman, Sophie Al; Solaini, Leonardo; Cheynel, N.

doi:10.9738/intsurg-d-14-00201.1

Cited by 9 publications

(17 citation statements)

References 9 publications

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“…5 )—9 papers reported cases with iliopsoas abscess (Table 1 ) [ 9 , 13 , 24 , 27 – 32 ] and 5 reported cases with subcutaneous emphysema and pneumomediastinum (Table 2 ). [ 3 , 7 , 8 , 20 , 33 ] This review of the literature seems to confirm our opinion that the presentation of perforated diverticulitis in the retroperitoneum have a different evolution than retroperitoneal perforation of colon cancer. [ 27 – 35 ] The management of retroperitoneal abscess from visceral perforation in complicated diverticular disease is still a challenge during the common surgical treatment of colonic diverticulitis.…”

Section: Discussionsupporting

confidence: 72%

“…In such cases, the causes of the infection are often both aerobic and anaerobic bacteria. [ 8 ] Retroperitoneal colonic perforation can be associated both with the diffusion of gases and pus into soft tissues. [ 7 , 9 ] Perforations of large bowel are rare but cause severe complications with overall mortality about 17%.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in these cases the diagnosis is often delayed and patients have multiple comorbidities. [ 8 , 11 ] The most common cause of colonic retroperitoneal perforation is diverticular disease. [ 8 ] The incidence of perforated colon cancer ranges from 3% to 10%.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 , 11 ] The most common cause of colonic retroperitoneal perforation is diverticular disease. [ 8 ] The incidence of perforated colon cancer ranges from 3% to 10%. [ 12 , 13 ] These 2 types of retroperitoneal perforations can be associated with 2 different clinical manifestations: subcutaneous emphysema with pneumomediastinum and muscle psoas abscesses.…”

Section: Discussionmentioning

confidence: 99%

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Clinical signs of retroperitoneal abscess from colonic perforation

Ruscelli

Renzi²,

Polistena

et al. 2018

Medicine

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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.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical signs of retroperitoneal abscess from colonic perforation

Ruscelli

Renzi²,

Polistena

et al. 2018

Medicine

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“…Pneumoretroperitoneum caused by colonic retroperitoneal perforation is a rare clinical condition, the most common cause of which is diverticular disease [ 4 ]. Colonic retroperitoneal perforation leads to the spread of abscess, gas and necrosis along the retroperitoneum, occasionally extending to the mediastinum.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal hematoma from lumbar artery as an unusual complication after rectal perforation with massive retroperitoneal emphysema

Miyata

Fujiwara

Nishijima

et al. 2018

Journal of Surgical Case Reports

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The patient was a 54-year-old woman diagnosed with adult Still’s disease, undergoing high-dose steroid and immunosuppressant therapy for 5 years, who was admitted to our hospital with abdominal pain. Computed tomography (CT) revealed pneumoperitoneum around the rectum and a large quantity of retroperitonal emphysema around the inferior vena cava, aorta and left kidney. An emergency laparotomy was performed. Intraoperative observation revealed a perforation on the mesenteric side of the rectum due to diverticulum, and Hartmann’s operation was performed. Deep tenderness and anemia were observed 4 days postoperatively. CT revealed extravasation in the left retroperitoneal space and a retroperitoneal hematoma, and emergency embolization of lumbar arteries was performed. Retroperitoneal bleeding associated with peritonitis after surgery is very rare. We surmised that higher-dose immunosuppressive therapy and gastrointestinal perforation with emphysema in the retroperitoneum induced lumbar artery bleeding. Clinicians should consider these factors as a potential cause of retroperitoneal hematoma.

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Progressive retroperitoneal abscess caused by colonic retroperitoneal perforation

Zhang¹,

Zhang²

2023

Asian Journal of Surgery

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Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Cited by 9 publications

References 9 publications

Clinical signs of retroperitoneal abscess from colonic perforation

Clinical signs of retroperitoneal abscess from colonic perforation

Retroperitoneal hematoma from lumbar artery as an unusual complication after rectal perforation with massive retroperitoneal emphysema

Progressive retroperitoneal abscess caused by colonic retroperitoneal perforation

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