Koroma Alizatu, Daley Rachel A, McMandon Alyssa, Biswas Saptarshi
Surgery, Trident Health System, North Charleston, USA.
Medical Student, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Cureus. 2025 May 17;17(5):e84272. doi: 10.7759/cureus.84272. eCollection 2025 May.
Acute diverticulitis commonly presents with abdominal symptoms but can rarely lead to extra-abdominal complications such as lower extremity necrotizing myositis. While fistulas involving the bladder or vagina are well described, retroperitoneal spread with extension into the thigh remains exceedingly uncommon. We present the case of a 77-year-old female who arrived with acute left thigh pain, swelling, and inability to bear weight. Initial workup was negative for deep vein thrombosis, but further history revealed preceding abdominal and back pain. Computed tomography identified extraluminal gas tracking from a perforated sigmoid colon into the retroperitoneum and anterior thigh. Exploratory laparotomy confirmed perforated diverticulitis with retroperitoneal fistulization and abscess formation extending into the thigh musculature. Surgical management included Hartmann's procedure, retroperitoneal washout, and debridement of necrotic thigh tissue. The patient recovered successfully following an intervention. This case underscores a rare but critical complication of diverticulitis, emphasizing the importance of considering intra-abdominal sources when encountering unexplained gas in the thigh. Timely diagnosis and aggressive surgical management are essential for optimal patient outcomes.
急性憩室炎通常表现为腹部症状，但很少会导致诸如下肢坏死性肌炎等腹部外并发症。虽然涉及膀胱或阴道的瘘管已有详细描述，但憩室炎经腹膜后扩散至大腿仍极为罕见。我们报告一例77岁女性患者，她因急性左大腿疼痛、肿胀且无法负重前来就诊。初步检查排除了深静脉血栓形成，但进一步询问病史发现患者之前有腹部和背部疼痛。计算机断层扫描显示，气体从穿孔的乙状结肠腔外进入腹膜后和大腿前部。剖腹探查证实为穿孔性憩室炎伴腹膜后瘘管形成及脓肿形成，并蔓延至大腿肌肉组织。手术治疗包括Hartmann手术、腹膜后冲洗以及坏死大腿组织清创术。患者经干预后成功康复。该病例强调了憩室炎一种罕见但严重的并发症，强调在大腿出现不明原因气体时考虑腹内病因的重要性。及时诊断和积极的手术治疗对于患者获得最佳预后至关重要。
