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Pneumomediastinum caused by colonic diverticulitis perforation
1Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Journal of the Korean Surgical Society
|November 9, 2011
Summary
Retroperitoneal diverticulitis perforation can cause rare pneumomediastinum. This life-threatening condition may be missed in patients without peritonitis, leading to delayed diagnosis and poor outcomes.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Radiology
Background:
- Diverticulitis perforation typically presents with peritonitis.
- Pneumomediastinum is an uncommon complication of colonic perforation.
Observation:
- A 59-year-old male presented with abdominal pain and acute nephrolithiasis.
- CT revealed a left para-renal and subphrenic abscess with unexpected pneumomediastinum.
- Surgical exploration identified retroperitoneal diverticulitis perforation of the sigmoid colon.
Findings:
- The patient underwent Hartmann's procedure for sigmoid colon resection.
- Postoperatively, the patient's condition deteriorated due to sepsis and multi-organ failure.
- The patient died on the 5th postoperative day.
Implications:
- Pneumomediastinum secondary to colonic diverticulitis is a rare but critical finding.
- Absence of peritonitis can delay diagnosis of colonic perforation.
- Prompt recognition and management are crucial for improving patient outcomes in such rare cases.
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