Abstract：
This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5-S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.
摘要：
该病例突出了乙状结肠憩室炎的罕见表现，伴有腹膜后穿孔并发脓肿，椎体骨髓炎和急性下肢缺血。一名40岁高龄的男子因左下肢急性缺血被送往急诊科。他心动过速伴有白细胞增多症,平淡无奇的腹部检查和无动于衷，麻木和瘫痪的左下肢。影像学显示乙状结肠增厚，与髂血管相邻的脓肿和左动脉闭塞。脓肿在L5-S1椎骨处与先前的脊柱前路腰椎椎间融合术（ALIF）硬件接触。病人被紧急送往手术室进行取栓,血栓切除术和筋膜切开术。他开始使用抗生素，后来接受了骨髓炎清创术的手术引流。复杂憩室炎的非手术治疗失败，需要开腹乙状结肠切除术。一年后,他没有症状，结肠造口术被逆转。
