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Conservative management of complex diverticular disease causing a retroperitoneal perforation
Jonathan Richard Rees1, Phillip Burgess
1Gloucestershire Royal Hospital, Colorectal Surgery, Great Western Road, Gloucester GL1 3NN, UK.
BMJ Case Reports
|October 7, 2011
Summary
Retroperitoneal perforation from diverticular disease is rare but can cause gas in leg muscles. Conservative management may be possible for unfit patients, even with a fecal fistula.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Diverticular disease is common, often causing psoas irritation via contiguous retroperitoneal inflammation.
- Retroperitoneal perforation, a rare complication, presents with free gas in retroperitoneal musculature.
Purpose of the Study:
- To present a rare case of retroperitoneal perforation due to diverticular disease.
- To discuss conservative management of this condition in a patient with comorbidities.
Main Methods:
- Case report of a 79-year-old woman.
- Clinical presentation of free gas in leg musculature.
- Conservative management approach due to comorbidities.
Main Results:
- The patient presented with free gas tracking into the lower limb musculature.
- A cutaneous fecal fistula formed in the lower limb.
- Conservative management was successfully implemented due to the patient's comorbidities.
Conclusions:
- Retroperitoneal perforation from diverticular disease is uncommon but can lead to extensive gas tracking.
- Conservative management, including drainage, may be feasible for unfit patients.
- Fecal fistula formation is a potential complication requiring careful management.
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