2017 Volume 37 Issue 3 Pages 483-487
A 66-year-old woman presented at the hospital complaining of fatigue, lower abdominal pain, and a neck pain that had begun one week previously. The patient was being treated with steroids for microscopic polyangiitis (MPA). Although the abdominal pain was slight and not severe, massive subcutaneous emphysema was observed from the neck to the precordia region. An investigational computed tomography examination was performed, revealing an abscess within the sigmoid mesocolon and emphysema within the retroperitoneum, mediastinum, and neck. An emergency operation was performed under a diagnosis of “perforated diverticulum of the sigmoid colon with severe retroperitoneal, mediastinal and cervical emphysema.” The clinical symptoms of intestinal perforations toward the retroperitoneum are much milder than those of perforations located toward the abdominal cavity, making them more difficult to discover and diagnose. In addition, the presently reported patient was a long-term steroid user because of her current condition (MPA), which might have alleviated the clinical symptoms to a level where a diagnosis was difficult.
