Idiopathic Retroperitoneal Perforation of the Descending Colon with Retroperitoneal Emphysema

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  • TOYOSHIMA Yujiro
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • INAGAKI Mitsuhiro
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • OKADA Naoki
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • YANAGIDA Naoyuki
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • AKABANE Hiromitsu
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • NAKANO Shiro
    Department of Surgery, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital
  • SATO Keisuke
    Department of Pathology, Hokkaido P.W.F.A.C. Asahikawa Kosei Hospital

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Other Title
  • 後腹膜気腫を伴う特発性下行結腸後腹膜穿孔の1例
  • 症例 後腹膜気腫を伴う特発性下行結腸後腹膜穿孔の1例
  • ショウレイ アトバラマクキシュ オ トモナウ トクハツセイ カコウケッチョウ アトバラマク センコウ ノ 1レイ

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Abstract

A 79-year-old man was brought by ambulance to our hospital with a history of left lower limb pain followed by back pain. He then developed difficulty with movement and was admitted to the orthopedic department for further evaluation. Abdominal CT on the 3rd hospital day showed abscess formation at the retroperitoneal space and extensive retroperitoneal emphysema extending from the ipsilateral iliac muscle to the fascial plain of the erector muscles of the spine. Ischemic colitis was identified at the descending colon around the abscess, so a retroperitoneal abscess and emphysema due to retroperitoneal perforation of the descending colon were suspected. A drainage tube was placed percutaneously, but the patient did not improve, and exploratory laparotomy was performed on the 5th hospital day. Laparotomy findings showed no infected ascites and no intraperitoneal abscess, and resection of the descending colon, and a descending colostomy were performed. Histopathological examination of the resected specimen showed micro-perforation of the descending colon and no malignancy. Postoperatively, the patient required critical care in the intensive care unit and percutaneous drainage, with two exchanges of the drainage tube. Fortunately, the patient recovered and was discharged on postoperative day 55.

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