Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum

Sivarajah, Vernon; Jones, Christopher B.; Pittathankal, Antony

doi:10.1016/j.ijscr.2013.01.031

Cited by 8 publications

(14 citation statements)

References 6 publications

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“…[1][2][3][4][5][6] Other causes can be cancer, colonic ischemia, toxic megacolon, iatrogenic perforation, or trauma. [1][2][3][4][5][6] The diagnosis can be challenging for surgeons, and it may be delayed, especially in the absence of peritoneal signs and abdominal pain. The presence of thigh cellulites (more frequent is the involvement of the left thigh in diverticular perforation), psoas irritation, and pylephlebitis can suggest a clinical presentation of an intra-abdominal infection.…”

Section: Discussionmentioning

confidence: 99%

“…1 No biochemical markers are currently available to detect this condition, unlike radiologic techniques, which can be very useful in these cases. 6 In particular, CT scan, in stable patients, can be useful to detect the indirect signs of colonic perforation, such as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, and gravity signs of abdominal infections, like pylephlebitis, portal vein gas and hepatic abscesses. However, it is not rare for diagnosis to be confirmed only intraoperatively or at histologic examination.…”

Section: Discussionmentioning

confidence: 99%

“…However, retroperitoneal ruptures can be difficult to diagnose because their presentation can vary widely. 1,2,[4][5][6] Through this case of retroperitoneal colonic perforation we aim to describe the presentation and therapeutic management of this entity.…”

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confidence: 99%

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Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Montori

Giovanni

Mzoughi

et al. 2015

International Surgery

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Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Montori

Giovanni

Mzoughi

et al. 2015

International Surgery

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“…The prevalence of diverticular disease ranges from 65% of those aged 85 years, 30% of those aged 60 years and in less than 5% in those aged 40 year. 2 …”

Section: Discussionmentioning

confidence: 99%

Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema

Kassir

Abboud

Dubois

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONAlthough diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature.PRESENTATION OF CASEWe report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated.DISCUSSIONSubcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes.CONCLUSIONThis physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis.

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“…Colonic diverticulosis is a common disease of the aging population of the Western world. The prevalence of diverticular disease ranges from 65% of those aged 85 years, 30% of those aged 60 years and in less than 5% in those aged 40 years [2] . Colonic diverticulosis is mostly symptomatic.…”

Section: Discussionmentioning

confidence: 99%

Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula

Amor

Kassir

Elias

et al. 2015

International Journal of Surgery Case Reports

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IntroductionDiverticular disease of the colon is a frequent pathology; however, perforated diverticulitis with a spontaneous sigmoidocutaneous fistula revealed by a perianal abscess is an uncommon presentation. We present this extremely rare case of a perforated sigmoid diverticulum in the perianal area, which is the first case that we have encountered in our practice and in the literature, along with the accompanying diagnostic and therapeutic issues and a review of the literature.Presentation of caseWe report the case of a 47-year-old man who was admitted to the emergency room due to a perianal abscess. The patient was taken to the operating room on an emergency basis. In the lithotomy position, the abscess was located at the 4 o’clock position. Incision and drainage was performed. Intraoperatively, the abscess was found to be deep, and considered an ischiorectal abscess. No fistulous tract was identified. An MRI of the pelvis was performed one month postoperatively which revealed a perforated diverticulitis of the sigmoid colon causing a perianal fistula. After the abscess was successfully treated, a sigmoidectomy was performed. Fifteen centimeters of the colon were resected. No postoperative complications occurred.DiscussionPerianal fistula is an obvious physical sign but its etiology is complex to determine. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the perianal tissue, allowing gas from a perforation to diffuse along tissue planes.ConclusionGeneral surgeons should bear in mind this rare presentation of a sigmoid diverticulitis.

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Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum

Abstract: Surgical emphysema in the abdominal wall is an indicator of retroperitoneal perforation, and its presence should be excluded before the possibility of perforation is dismissed. This may be of especial value in younger age groups amongst whom perforation may be less clinically obvious.

Cited by 8 publications

References 6 publications

Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema

Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula

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