Montori Giulia, Di Giovanni Giacomo, Mzoughi Zeineb, Angot Cedric, Al Samman Sophie, Solaini Leonardo, Cheynel Nicolas
1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
2 Surgical Clinic, Department of Clinical and Surgical Sciences, University of Brescia, Brescia, Italy.
Int Surg. 2015 Jun;100(6):984-8. doi: 10.9738/INTSURG-D-14-00201.1.
Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.
左半结肠穿孔通常发生在复杂性憩室炎或癌症中。最常见的体征是腹腔内脓肿或腹膜炎。对于腹膜后结肠穿孔病例，诊断可能困难。一名59岁女性出现左大腿疼痛以及伴有轻度呼吸困难的腹部不适。计算机断层扫描显示腹膜后有气泡和脓性积液，皮下气肿从左大腿延伸至颈部。计算机断层扫描还显示门静脉气体和血栓形成以及多个肝脓肿。急诊剖腹探查发现左半结肠近端穿孔。未发现肿块。进行了左半结肠切除术。广泛引流和冲洗腹膜后间隙。应用了负压伤口治疗。48小时后进行了二次剖腹探查。引流腹膜后间隙并进行了结肠造口术。术后在重症监护病房停留9天，患者在术后第32天出院。腹膜后积气和纵隔积气是结肠腹膜后穿孔的罕见体征。诊断可能会延迟，尤其是在没有腹膜刺激的情况下。临床、实验室检查，尤其是影像学参数可能会有所帮助。必须迅速进行手术治疗以改善预后。
