Choi Pyong Wha
Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
J Korean Surg Soc. 2011 Jun;80 Suppl 1(Suppl 1):S17-20. doi: 10.4174/jkss.2011.80.Suppl1.S17. Epub 2011 Jun 17.
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.
一名59岁男性因腹部及左胁腹疼痛就诊。症状始于30天前，起初为急性肾结石，尽管采取了保守治疗，但病情仍恶化。腹部稍膨隆，下腹部压痛，无弥漫性腹膜炎体征。计算机断层扫描（CT）显示左肾旁间隙直至膈下间隙有脓肿形成，且意外发现纵隔气肿。遂行急诊手术，术中见乙状结肠降结肠交界处腹膜后憩室炎穿孔并形成脓肿。行病变结肠节段切除及结肠造口术（哈特曼手术）。然而，患者病情逐渐恶化，术后第5天死于败血症和多器官功能衰竭。尽管结肠憩室炎穿孔导致的纵隔气肿极为罕见，但对于无腹膜炎体征的患者，因其诊断延迟，可能会危及生命。
