J Korean Surg Soc.  2011 Jun;80(Suppl 1):S17-S20. 10.4174/jkss.2011.80.Suppl1.S17.

Pneumomediastinum caused by colonic diverticulitis perforation

• Choi PW

• KMID: 2096643
• DOI: http://doi.org/10.4174/jkss.2011.80.Suppl1.S17

Abstract

A 59-year-old man presented with abdominal and left flank pain. The symptom had started 30 days before as an acute nephrolithiasis, which had worsened despite conservative management. The abdomen was slightly distended and tender over the lower abdomen, without signs of generalized peritoneal irritation. A computed tomography (CT) scan showed an abscess in left para-renal space up to the subphrenic space and an unexpected pneumomediastinum. An emergency operation was performed, which showed retroperitoneal diverticulitis perforation of the sigmoid descending junction with abscess formation. A segmental resection of the diseased colon and end-colostomy was performed (Hartmann's procedure). However, the patient's condition progressively deteriorated, and he died of sepsis and multi-organ failure on the 5th postoperative day. Although pneumomediastinum caused by colonic diverticulitis perforation is extremely rare, it could be a life-threatening condition in patients without signs of peritonitis because of delayed diagnosis.

Keyword

Pneumomediastinum; Diagnostic; Diverticulitis; Colonic; Perforation

MeSH Terms

Abdomen
Abscess
Colon
Colon, Sigmoid
Delayed Diagnosis
Diverticulitis
Diverticulitis, Colonic
Emergencies
Flank Pain
Humans
Mediastinal Emphysema
Middle Aged
Nephrolithiasis
Peritonitis
Sepsis

Figure

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  Fig. 1 Chest x-ray shows scanty bilateral pleural effusion and focal increased density in left lower lobe. No air was demonstrated in the peritoneal cavity or mediastinum.

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  Fig. 2 Simple abdomen shows no significant abnormality in bowel gas pattern or definite free air in peritoneal space except degenerative spondylosis of lumbar spine.

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  Fig. 3 Computed tomography scan (coronal image) shows an infiltrative mass in the posterolateral portion of the descending colon (arrow) and massive air bubbles in the left pararenal space, the left costodiaphragmatic recess, and around the body of the stomach, with diffuse infiltrates into the left soft tissue.

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  Fig. 4 Computed tomography scan of the chest (axial image) shows air in the mediastinum (pneumomediastinum) (arrows).

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