Subcutaneous emphysema of the neck, chest, and abdomen as a symptom of colonic diverticular perforation into the retroperitoneum

Janczak, Dariusz; Ziomek, Agnieszka; Dorobisz, T; Dorobisz, Karolina; Jańczak, Dawid; Pawłowski, Wiktor; Chabowski, Mariusz

doi:10.5114/kitp.2016.58968

Cited by 3 publications

(2 citation statements)

References 8 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%

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%

Clinical signs of retroperitoneal abscess from colonic perforation

Ruscelli

Renzi²,

Polistena

et al. 2018

Medicine

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“…2 It may also result from inflammatory colonic diseases. 1 Many cases have been treated conservatively, but in a patient with associated free air, intraperitoneal perforation, and peritonitis, surgery should be standard management.…”

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confidence: 99%

Bowel Perforation Presenting as Head and Neck Subcutaneous Emphysema

Leto

Clar

Goodman

2021

The American Surgeon™

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This patient with Crohn's disease underwent endoscopic balloon dilatation of an ileocolic stricture, and shortly thereafter developed subcutaneous emphysema in the soft tissues of her face, neck, and chest wall. Clinical evaluation and imaging revealed peritonitis from perforated bowel. She underwent laparotomy and bowel resection and recovered well. Subcutaneous emphysema in the head and neck from perforated bowel is a rare but recognized presentation of viscus perforation.

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Complicated retroperitoneal diverticulitis presenting with abscess and acute limb ischemia

Gunasingha,

Seoudi,

Mirza

et al. 2024

BMJ Case Rep

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This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5–S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.

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Subcutaneous emphysema of the neck, chest, and abdomen as a symptom of colonic diverticular perforation into the retroperitoneum

Cited by 3 publications

References 8 publications

Clinical signs of retroperitoneal abscess from colonic perforation

Clinical signs of retroperitoneal abscess from colonic perforation

Bowel Perforation Presenting as Head and Neck Subcutaneous Emphysema

Complicated retroperitoneal diverticulitis presenting with abscess and acute limb ischemia

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