Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report.

Publisher: BioMed Central Country of Publication: England NLM ID: 101293382 Publication Model: Electronic Cited Medium: Internet ISSN: 1752-1947 (Electronic) Linking ISSN: 17521947 NLM ISO Abbreviation: J Med Case Rep Subsets: MEDLINE

Original Publication: [London] : BioMed Central, [2007-

Retropneumoperitoneum*/etiology ; Retropneumoperitoneum*/complications ; Mediastinal Emphysema*/diagnostic imaging ; Mediastinal Emphysema*/etiology ; Mediastinal Emphysema*/therapy ; Pneumoperitoneum*/diagnostic imaging ; Pneumoperitoneum*/etiology ; Diabetes Mellitus, Type 2*/complications ; Peritonitis*/diagnosis ; Diverticulitis* ; Intestinal Perforation*/surgery; Humans ; Female ; Aged

Background: Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.
Case Presentation: A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.
Conclusions: This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.
(© 2024. The Author(s).)

Ann R Coll Surg Engl. 2017 Nov;99(8):e241-e243. (PMID: 29022798)
Can J Gastroenterol. 2007 Feb;21(2):97-9. (PMID: 17299613)
Ulus Travma Acil Cerrahi Derg. 2011 Jan;17(1):93-5. (PMID: 21341144)
Case Rep Radiol. 2014;2014:431563. (PMID: 25136471)
Int J Surg Case Rep. 2019;55:213-217. (PMID: 30771625)
J Gastrointest Surg. 2007 Apr;11(4):542-8. (PMID: 17436142)
Insights Imaging. 2017 Feb;8(1):19-27. (PMID: 27878550)

Keywords: Case report; Diverticulitis; Perforated; Perforation; Peritonitis; Pneumomediastinum; Pneumoperitoneum; Pneumoretroperitoneum

Date Created: 20240416 Date Completed: 20240418 Latest Revision: 20240425

20240425

PMC11022365

10.1186/s13256-024-04488-1

38627832