title: Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation.
abstract: 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.
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Giulia
authors.initials: G
authors.lastname: Montori
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Zeineb
authors.initials: Z
authors.lastname: Mzoughi
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Angot
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Al Samman
authors.affiliation: 2 Surgical Clinic, Department of Clinical and Surgical Sciences, University of Brescia, Brescia, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Solaini
authors.affiliation: 1 Department of General and Emergency Surgery, Centre Hospitalier Universitaire Bocage, Dijon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Cheynel
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D003082:Colectomy; D003125:Colostomy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000601:surgery*; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012188:Retropneumoperitoneum / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Colonic; Perforation; Pneumomediastinum; Retroperitoneum