Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-024-04488-1 |
| _version_ | 1797199394650456064 |
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| author | H. Hafiani N. Bouknani E. M. Choukri R. Charif Saibari A. Rami |
| author_facet | H. Hafiani N. Bouknani E. M. Choukri R. Charif Saibari A. Rami |
| author_sort | H. Hafiani |
| collection | DOAJ |
| description | Abstract 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. Case presentation 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. |
| first_indexed | 2024-04-24T07:15:04Z |
| format | Article |
| id | doaj.art-4823cc5b25d94d3e8ace346b0779c03b |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-24T07:15:04Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-4823cc5b25d94d3e8ace346b0779c03b2024-04-21T11:20:04ZengBMCJournal of Medical Case Reports1752-19472024-04-011811410.1186/s13256-024-04488-1Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case reportH. Hafiani0N. Bouknani1E. M. Choukri2R. Charif Saibari3A. Rami4Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS)Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS)Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS)Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS)Cheikh Khalifa International Hospital, Mohamed VI University of Health Sciences (UM6SS)Abstract 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. Case presentation 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.https://doi.org/10.1186/s13256-024-04488-1PneumomediastinumPneumoperitoneumPneumoretroperitoneumPerforationPerforatedPeritonitis |
| spellingShingle | H. Hafiani N. Bouknani E. M. Choukri R. Charif Saibari A. Rami Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report Journal of Medical Case Reports Pneumomediastinum Pneumoperitoneum Pneumoretroperitoneum Perforation Perforated Peritonitis |
| title | Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report |
| title_full | Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report |
| title_fullStr | Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report |
| title_full_unstemmed | Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report |
| title_short | Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report |
| title_sort | pneumoperitoneum pneumoretroperitoneum and pneumomediastinum rare complications of perforation peritonitis a case report |
| topic | Pneumomediastinum Pneumoperitoneum Pneumoretroperitoneum Perforation Perforated Peritonitis |
| url | https://doi.org/10.1186/s13256-024-04488-1 |
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