Retroperitoneal Perforation in Ulcerative Colitis with Mediastinal and Subcutaneous Emphysema

Alvares, Jose Filipe; Dhawan, Pankaj; Tibrewala, S; Shankaran, K; Kulkarni, Sanjay; Rananavare, R; Kalro, R H

doi:10.1097/00004836-199709000-00012

Cited by 10 publications

(11 citation statements)

References 11 publications

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“…Th ere are nine reported cases of spontaneous pneumomediastinum in association with infl ammatory bowel disease, most commonly ulcerative colitis, and in the absence of evidence of perforation (5)(6)(7)(8)(9)(10)(11)(12). In our patient who was not coughing or actively vomiting and had no underlying lung disease or perforation of a viscous, the spontaneous pneumomediastinum was thought to be a complication of his severe colitis.…”

Section: Discussionmentioning

confidence: 67%

“…In spontaneous pneumomediastinum, nonoperative management is often most eff ective (2,15,16). In IBD-associated pneumomediastinum, management of IBD symptoms has been reported to result in resolution of mediastinal air (6,8,11,12). Although the decision to pursue surgery in this case was unrelated to the pneumomediastinum, persistent pneumomediastinum may refl ect a severe degree of colitis that may necessitate surgical intervention.…”

Section: Discussionmentioning

confidence: 83%

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Pneumomediastinum in Inflammatory Bowel Disease

Mihatov

Fenves

2015

Baylor University Medical Center Proceedings

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 83%

Pneumomediastinum in Inflammatory Bowel Disease

Mihatov

Fenves

2015

Baylor University Medical Center Proceedings

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“…Air bubbles can be found to persist in the epidural or subararachnoid space for days after epidural block with air. In patients with subcutaneous or eyelid emphysema, the absorption of air could last several days up to two weeks [12]. One would expect, however, that the amount of air should be significantly decreased four days after surgery.…”

Section: Discussionmentioning

confidence: 99%

Pneumoretroperitoneum after Attempted Epidural Anesthesia

Isakov

Shtein

Kyzer

2016

The Journal of Critical Care Medicine

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Air may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described. Case reportAn 81-year-old, Caucasian, male, weight 72 kg, height 178 cm, was admitted due to fracture of the neck of the right femur. The patient was operated on, and internal fixation of the fracture was performed. Epidural anesthesia at the L4-5 level in the right the lateral position was performed by a second-year anesthesia resident. A midline approach and an 18G Tuohy needle were used. The procedure was technically difficult, and a total of three attempts were made. Loss of resistance with air was used. During the efforts to identify the epidural space, some 30 to 35 milliliters of air had been injected. Subjective loss of resistance was reported by the performing anesthesiologist. However, he was unable to insert an epidural catheter. Local anesthetic was not injected. The procedure was eventually carried out without intraoperative complications under general anesthesia. On the fourth postoperative day, the patient developed continuous abdominal pain of moderate severity. On examination, there were no signs of peritoneal irritation. However, an abdominal CT scan demonstrated air in the retroperitoneum around the left psoas muscle (Figure 1). Because the patient had received an enema on the third postoperative day, a gastrografin enema was performed to rule out rectal or colonic perforation. No leak was demonstrated. CT examination confirmed air around the left psoas muscle which extended to the left paravertebral muscles. There was no air around the pelvic organs or at the site of the femoral fixation. The patient's condition improved gradually, and he was discharged on the seventh postoperative day. The patient agreed with presentation of his data and all the procedures performed were approved by the institution where the patient was treated.

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“…1 Because the fascial planes of the cervical soft tissues are in continuity with those of the mediastinum and through the diaphragmatic hiatus with the retroperitoneal soft tissue space, the air from the retroperitoneal area can track to the subcutaneous tissues in the neck and mediastinum. [3][4][5][6][7] In our case, the gas might spread into the peritoneal cavity along two routes. The gas moved directly from the retroperitoneum to the peritoneal cavity or indirectly via retroperitoneum and mediastinum to peritoneal cavity.…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum, Pneumopericardium, and Pneumoperitoneum Caused by Peridiverticulitis of the Colon: Report of a Case

Bešič

Žgajnar²,

Kocijančič³

2004

Diseases of the Colon &Amp; Rectum

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A 50-year-old woman with breast carcinoma metastases in the left supraclavicular region was treated because of free air in the mediastinum, around the heart and vascular pedicle, below the diaphragmatic dome, and subcutaneous neck and supraclavicular emphysema, without radiologic signs of pneumothorax. Diverticulosis of the colon and an occult perforation of the diverticulum in the retroperitoneal region of the colon were diagnosed. The patient was treated by segmental resection of the colon with anastomosis, drainage of the abdominal cavity, and antibiotics. To our knowledge, this is the only report in the literature about pneumopericardium caused by peridiverticulitis of the colon.

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Retroperitoneal Perforation in Ulcerative Colitis with Mediastinal and Subcutaneous Emphysema

Cited by 10 publications

References 11 publications

Pneumomediastinum in Inflammatory Bowel Disease

Pneumomediastinum in Inflammatory Bowel Disease

Pneumoretroperitoneum after Attempted Epidural Anesthesia

Pneumomediastinum, Pneumopericardium, and Pneumoperitoneum Caused by Peridiverticulitis of the Colon: Report of a Case

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