背景:穿孔憩室炎引起的气体外渗并发症很常见,但表现为气腹,气后腹膜,同时发生的纵隔气肿极为罕见。本病例报告探讨了同时发生的这3种并发症的独特表现,他们的诊断和管理,强调跨学科合作对准确诊断和有效管理的重要性。
方法:一位74岁的北非女性,有包括高血压在内的病史,血脂异常,2型糖尿病,甲状腺肿,先前的胆囊切除术,双侧全膝关节置换术,突然出现骨盆疼痛,慢性便秘,直肠出血.临床检查显示血流动力学不稳定,低氧血症,和弥漫性压痛。在使用去甲肾上腺素和生理盐水血清进行适当的液体复苏后,患者足够稳定,可以接受计算机断层扫描。急诊计算机断层扫描扫描证实直肠乙状结肠交界处穿孔憩室炎,伴随着前所未有的气腹,气后腹膜,和肺纵隔。患者接受了结肠直肠切除术和Hartmann结肠造口术的及时手术干预。术后病程良好,导致入院后一周出院。
结论:本病例报告强调了穿孔憩室炎中气体外渗并发症的临床新颖性。独特的气腹三联征,气后腹膜,一名74岁女性的纵隔气肿和纵隔气肿强调了诊断挑战和先进成像技术的重要性。放射科医生和外科医生之间的成功合作促进了及时准确的诊断,实现微创手术方法。此病例有助于理解憩室炎的非典型表现,并强调了跨学科团队合作在管理此类罕见表现中的重要性。
BACKGROUND: Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as
pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This
case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.
METHODS: A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.
CONCLUSIONS: This
case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of
pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This
case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.