Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation |
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| Authors: | Giulia Montori Giacomo Di Giovanni Zeineb Mzoughi Cedric Angot Sophie Al Samman Leonardo Solaini Nicolas Cheynel |
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| Institution: | 1.Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France ;2.Surgical Clinic, Department of Clinical and Surgical Sciences, University of Brescia, Brescia, Italy |
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| Abstract: | 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.Key words: Pneumomediastinum, Retroperitoneum, Colonic, PerforationColonic perforation can be caused by either benign or malignant diseases. Left colon perforation is generally due to diverticular disease or cancer.1–3 Uncommon causes are iatrogenic ischemia, colonic ischemia, trauma, or toxic megacolon.1,3,4 Symptoms are usually due to abscesses or peritonitis. However, retroperitoneal ruptures can be difficult to diagnose because their presentation can vary widely.1,2,4–6Through this case of retroperitoneal colonic perforation we aim to describe the presentation and therapeutic management of this entity. |
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