Case report
Perforation of sigmoid diverticulitis: Unusual cause of subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumoretroperitoneum and pneumoperitoneum
Marin Pušić
; Katedra za radiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Slavica Kovačić
; Katedra za radiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Siniša Knežević
; Klinički zavod za radiologiju, KBC Rijeka, Rijeka
Marko Zelić
; Katedra za kirurgiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Damir Miletić
; Katedra za radiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Abstract
Aim: The aim of this paper is to present a very rare case of sigmoid diverticulitis perforation with pain in the lower left abdomen, subfebrility and subcutaneous emphysema of the neck at presentation. Case report: Thirty six year old patient was admitted to the Department of neurosurgery for an elective operative procedure because of a longstanding left-sided lower back pain. Early postoperative course was complicated with gradually increasing pain in her lower left abdomen, subfebrility, increase in inflammatory markers and subcutaneous emphysema of the neck. Extensive imaging workup was performed (plain radiographs of the neck, thorax and abdomen, CT of the neck, thorax, abdomen and pelvis, MRI of the abdomen and pelvis) and large amount of free air in the soft tissues of the neck, in the mediastinum, pleural space, retroperitoneum and peritoneum was demonstrated. Diverticulosis of the sigmoid colon with stranding of the adjacent fat was also noted. These findings were suggestive of a perforated sigmoid diverticulitis which was confirmed by operative procedure and pathohistological report. Her postoperative course after laparotomy was unremarkable. Conclusion: Sigmoid diverticulitis perforation is a very unusal cause of subcutaneous emphysema of the neck, pneumomediastinum, pneumothorax, pneumoretroperitoneum and pneumoperitoneum that should be considered because many complications, including death, may occure if accurate diagnosis and laparotomy are delayed.
Keywords
diverticulitis; perforation; pneumomediastinum; pneumoperitoneum; pneumoretroperitoneum; subcutaneous emphysema
Hrčak ID:
158638
URI
Publication date:
1.6.2016.
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