title: Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema.
abstract: BACKGROUND
  Although diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature.
  
  
  METHODS
  We report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated.
  
  
  CONCLUSIONS
  Subcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes.
  
  
  CONCLUSIONS
  This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis.
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France. Electronic address: Radwankassir42@hotmail.Fr.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Abboud
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Joelle
authors.initials: J
authors.lastname: Dubois
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Baccot
authors.affiliation: Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Debs
authors.affiliation: Department of Cardiac Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Favre
authors.affiliation: Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Gastaldi
authors.affiliation: Department of General Surgery, CHU Nice, Archet 2 Hospital, Nice, France.
authors.forename: Imed Ben
authors.initials: IB
authors.lastname: Amor
authors.affiliation: Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
keywords: Acute abdomen; Colonic diverticulosis; Perforation; Subcutaneous emphysema; Surgery