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Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-o...
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Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-o...
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Citations
... The latter led us to review the literature to establish the usefulness of this imaging tool. In 1961 Rafailidis et al. 16 demonstrated that the presence of superficial gas in the abdominal wall or in the thigh may be secondary to intraabdominal events or to a retroperitoneal abscess. This association was established for the first time by Rodlaha in 1926, in a patient with subcutaneous emphysema, with a sub-diaphragmatic abscess caused by gastric ulcer perforation. ...
Background Diverticular disease, and the diverticulitis, the main complication of it, are widely studied diseases with multiple chronic cases reported in the literature, but there are no atypical presentations with extra-abdominal symptoms coupled with seemingly unrelated entities, such as necrotising fasciitis. Clinical case Female 52 years old, was admitted to the emergency department with back pain of 22 days duration. History of importance: Chronic use of benzodiazepines intramuscularly. Physical examination revealed the presence of a gluteal abscess in right pelvic limb with discoloration, as well as peri-lesional cellulitis and crepitus that stretches across the back of the limb. Fasciotomy was performed with debridement of necrotic tissue. Progression was torpid with crackling in abdomen. Computed tomography showed free air in the cavity, and on being surgically explored was found to be complicated diverticular disease. Discussion It is unusual for complicated diverticular disease to present with symptoms extra-peritoneal (< 2%) and even more so that a diverticulitis is due to necrotising fasciitis (< 1%). The absence of peritoneal manifestations delayed the timely diagnosis, which was evident with the crackling of the abdomen and abdominal computed tomography scan showing the parietal gaseous process. Conclusion All necrotising fasciitis needs an abdominal computed tomography scan to look for abdominal diseases (in this case diverticulitis), as their overlapping presentation delays the diagnosis and consequently the treatment, making a fatal outcome inevitable.
... [8] Similarly acute perforated diverticulitis of sigmoid colon is also known to present as anterior abdominal wall abscess. [9] The inflammatory pathologies in abdominal hollow viscera are known to have inflammation, suppuration, abscess and fistula formation but intra abdominal abscess formation are common than parietal wall abscess. The chronic inflammatory like actinomycosis, crohn's disease and tuberculosis are known to cause anterior abdominal wall abscess and fistula formation and must be considered in differential diagnosis. ...
... Esto último nos lleva a una revisión bibliográfica para establecer la utilidad de dicho estudio de imagen. Rafailidis et al. 16 en 1961 demostraron que la presencia de gas superficial en la pared abdominal o en los muslos puede ser secundaria a eventos intraabdominales o a absceso retroperitoneal. Esta asociación fue establecida por primera vez por Rodlaha en 1926, en un paciente con enfisema subcutáneo con absceso subdiafragmático causado por perforación de úlcera gástrica. ...
Background:
Diverticular disease, and the diverticulitis, the main complication of it, are widely studied diseases with multiple chronic cases reported in the literature, but there are no atypical presentations with extra-abdominal symptoms coupled with seemingly unrelated entities, such as necrotising fasciitis.
Clinical case:
Female 52 years old, was admitted to the emergency department with back pain of 22 days duration. History of importance: Chronic use of benzodiazepines intramuscularly. Physical examination revealed the presence of a gluteal abscess in right pelvic limb with discoloration, as well as peri-lesional cellulitis and crepitus that stretches across the back of the limb. Fasciotomy was performed with debridement of necrotic tissue. Progression was torpid with crackling in abdomen. Computed tomography showed free air in the cavity, and on being surgically explored was found to be complicated diverticular disease.
Discussion:
It is unusual for complicated diverticular disease to present with symptoms extra-peritoneal (< 2%) and even more so that a diverticulitis is due to necrotising fasciitis (< 1%). The absence of peritoneal manifestations delayed the timely diagnosis, which was evident with the crackling of the abdomen and abdominal computed tomography scan showing the parietal gaseous process.
Conclusion:
All necrotising fasciitis needs an abdominal computed tomography scan to look for abdominal diseases (in this case diverticulitis), as their overlapping presentation delays the diagnosis and consequently the treatment, making a fatal outcome inevitable.
... Diverticular disease affects mainly patients over forty years of age especially in the western countries, with left colon representing the most common site of presentation [1]. Most patients remain asymptomatic, while 20% of cases present symptoms [2]. ...
... However, it can also appear with nontypical signs, through complications such as chronic abscesses, the creation of fistulae, and bowel obstruction. Therefore, cases have been reported that presented with colovesical and colovaginal fis- tulae [6], perianal fistulae [7] , abscess formation on the abdominal wall [1], the thigh [6] , or the renal fossa during endstage renal disease [8], subcutaneous emphysema [9], and a perforation in a lumbar hernia [10]. In our case, the perforation appeared as a left lumbar area abscess of three-month duration, for which the patient did not seek treatment before, as he did not present any other symptoms. ...
Diverticular perforation is a common complication of diverticulitis and can lead to the creation of abscesses. The presence of such abscesses on the abdominal wall is rare and can lead to misdiagnosis. We present the case of a patient with abdominal pain and the formation of a large left lumbar abscess due to perforation of a diverticulum of the left colon and our surgical treatment of choice with favorable results.
