Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS), Ave Mohamed Taieb Naciri, Casablanca, Morocco.
J Med Case Rep. 2024 Apr 17;18(1):187. doi: 10.1186/s13256-024-04488-1.
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.
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.
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.
由穿孔性憩室炎引起的气体外渗并发症很常见，但同时出现气腹、腹膜后气肿和纵隔气肿的表现极为罕见。本病例报告探讨了这 3 种并发症同时发生的独特表现、诊断和处理方法，强调了跨学科合作对于准确诊断和有效处理的重要性。
一位 74 岁的北非女性，既往有高血压、血脂异常、2 型糖尿病、甲状腺肿、胆囊切除和双侧全膝关节置换术病史，因突发骨盆疼痛、慢性便秘和直肠出血就诊。临床检查发现血流动力学不稳定、低氧血症和弥漫性压痛。在使用去甲肾上腺素和生理盐水进行适当的液体复苏后，患者的情况稳定到足以进行计算机断层扫描检查。紧急计算机断层扫描确认了直肠乙状结肠交界处的穿孔性憩室炎，同时存在前所未有的气腹、腹膜后气肿和纵隔气肿。患者接受了紧急手术干预，进行结肠直肠切除和 Hartmann 结肠造口术。术后恢复顺利，患者在入院后一周出院。
本病例报告突出了穿孔性憩室炎气体外渗并发症的临床新颖性。74 岁女性同时出现气腹、腹膜后气肿和纵隔气肿的独特三联征突出了诊断挑战和高级影像学技术的重要性。放射科医生和外科医生的成功合作促进了及时和准确的诊断，实现了微创外科手术方法。本病例有助于了解憩室炎的非典型表现，并强调了跨学科团队合作在处理这种罕见表现中的重要性。
