Subcutaneous Emphysema of a Neck and Extensive Phlegmon of a Lower Limb as the First Symptoms of Large Intestine Perforation

• Authors: Aleksandra Wawrzak , Janusz Korlacki , Michał Głowacz
• Languages of publication: EN

Abstracts

EN

This research has presented two cases of clinically silent perforation of the large intestine. The first symptoms were the following: subcutaneous emphysema of the neck, nasal speech, and extensive phlegmon of a lower limb. In both cases diagnoses were difficult and the treatment was delayed due to intestine perforation into the retroperitoneal space and lack of acute abdominal symptoms. This article explains the anatomical base of spreading infection from the retroperitoneal space to distant areas. The possibility of such uncommon complications reminds of holistic approach to every patient and thorough physical examination.

Keywords

EN

large intestine perforation; subcutaneous emphysema; phlegmon; retroperitoneal space

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 8
• Pages: 348-353

Dates

published

1 - 8 - 2009

online

22 - 10 - 2010

Contributors

author

Aleksandra Wawrzak

• Surgical Department, Complex of Municipal Hospitals in Chorzów

author

Janusz Korlacki

• Surgical Department, Complex of Municipal Hospitals in Chorzów

author

Michał Głowacz

• Surgical Department, Complex of Municipal Hospitals in Chorzów

References

• Meyers MA: Radiological features of the spread and localization of extraperitoneal gas and their relationship to its source. An anatomical approach. Radiology 1974; 111: 17-26.[PubMed]
• Feldman MG, Lustberg H: Pneumomediastinum: retroperitoneeal pathway. Conn Med 1999; 63(10): 579-82.
• Holton L, Migaly J, Rolandelli R: Pneumorrhachis, subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumoretroperitoneum after proctocolectomy for ulcerative colitis. Dis Colon Rectum 2002; 45: 567-70.[PubMed][Crossref]
• Van Oers J Ponssen HH Hesp W: Pneumopericardium, pneumomediastinum and mediastinal abscess secondary to diverticulitis of the sigmoid. Intensive Care Med 2000; 26: 1867-68.
• Cohen M, Kleinman M: Pneumomediastinum during relapse of ulcerative colitis. Am J Gastroenterology 1997; 92(12): 2306-07.
• Utzig MJ, Foitzik Th, Buhr HJ i wsp: Pneumomediastinum und Pneumothorax als manifestation eines Ulcus duodeni - Fallbeschreibung. Zentralbl Chir 2002; 127: 1091-93.[Crossref]
• Webb T: Pneumothorax and pneumomediastinum during colonoscopy. Anesth Intensive Care 1998; 26: 302-04.
• Piechota M, Sygut A, Dziki A: Przypadek odmy podskórnej, środpiersiowej i otrzewnowej jako pierwszy objaw nieszczelności zespolenia esiczoodbytniczego po zabiegu niskiej przedniej resekcji odbytnicy. Pol Przegl Chir 2005; 77(6): 602-08.
• Maunder RJ, Pierson DJ, Hudson LD: Subcutaneous and mediastinal emphysema, pathophysiology, diagnosis and management. Arch Intern Med 1984; 144: 1447-53.[Crossref][PubMed]
• Clements RH, Reddy S, Holzman MD: Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery. Surg Endosc 2000; 14(6): 553-55.[PubMed][Crossref]
• Harris JA, Gallo CD, Brummett DM et al.: Extraabdominal pneumodissection after laparoscopic antireflux surgery. Am Surg 2001; 67(9): 885-89.
• Puccio F, Solazzo M, Chiodini S: Primary retroperitoneal abscess extending to the calf. Arch Surg 2005; 140(12): 1230-31.
• Meyers MA, Goodman KJ: Pathways of extrapelvic spread of disease: Anatomic-radiologic correlation. Am J Roentgenol Radium Ther Nucl Med 1975; 125(4): 900-09.
• Hsieh CH, Wang YC, Yang HR.: Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: an extremely fulminant form of a common disease. World J Gastroenterol 2006; 12(3): 496-99.
• El-Masry NS, Theodorou NA: Retroperitoneal perforation of the appendix presenting as right thigh abscess. Int Surg 2002; 87(2): 61-64.
• Balázs A, Lukovich P, Flautner L: A case of retroperitoneal pancreatic abscess spreading to the femoral region. Orv Hetil 2000; 141(5): 241-44.
• Ravo B, Khan SA., Ger R i wsp.: Unusual extraperitoneal presentations of diverticulitis. Am J Gastroenterol 1985; 80(5): 346-51.
• Kobayashi H, Sakurai Y, Shoji M et al.: Psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum. J Gastroenterol 2001; 36(9): 623-28.[Crossref]
• Seirsen M, Werther K, Noer HH: Non-traumatic subcutaneous emphysema of the femur. A rare complication of colorectal cancer. Ugeskr Laeger 1997; 159(50): 7505-06.
• Lam TP, Maffulli N, Chen Ehi wsp.: Carcinomatous perforation of the sigmoid colon presenting as a thigh mass. Bull Hosp Jt Dis 1996; 55(2): 83-85.
• Luning TH, Keemers-Gels ME, Barendregt WB et al.: Colonoscopic perforations: a review of 30,366 patients. Surg. Endosc 2007; 21: 994-97.
• Blachar A, Sosna J: CT colonography/virtual colonoscopy/:technique, indications and performance. Digestion 2007; 76: 34-41.[PubMed][Crossref][WoS]
• Lefere P, Dachman AH, Gryspeerdt S: Computed tomographic colonography: clinical value. Abdom Imaging 2007; 32: 541-51.[PubMed][Crossref]
• Wax BN, Katz DS, Badler RL et al.: Complications of abdominal and pelvic procedures: computed tomographic diagnosis. Curr Probl Diagn Radiol 2006;35:171-87.[Crossref]
• Ortega-Carnicer J: Pneumothorax, pneumoperitoneum and retropneumoperitoneum due to spontaneous colon perforation. Med Intensiva 2006; 30:82-83.
• Tandon T, Moss M.C, Shaik M et al.: Perforated colonic diverticulum presenting as necrotizing fascitis of the thigh. J Orthop Sci 2005; 10: 534-36.[Crossref]
• Tsai HL, Liu CS, Chang JW et al.: Sewere necrotizing fascitis of the abdominal wall secondary to colon perforation in a child. J Chin Med Assoc 2008; 71: 259-61.[Crossref][WoS]
• Kawai K, Hiramatsu T, Kobayashi R et al.: Coagulation disorder as a prognostic factor for patients with colorectal perforation. J Gastroenterol 2007; 42: 450-55.[Crossref]
• Busic Alfonso-Ballester R, Lo Pez-Mozos F et al.: Laparoscopic treatment of endoscopic sigmoid colon perforation: a case report and literature review. Surg Laparosc Endosc Percutan Tech 2007; 17: 44-46.
• Busić Z, Lovric Z, Busić V et al.: Laparoscopic treatment of iatrogenic endoscopic sigmoid colon perforation: a case report and literature review. J Laparoendosc Adv Surg Tech A 2007;17: 324-25.[WoS]

Identifiers

DOI

10.2478/v10035-009-0058-1