A case of idiopathic perforation of the colon presenting with retroperitoneal emphysema

Abstract

The symptoms associated with intramesenteric perforation of the colon progress slowly compared to the symptoms associated with intraperitoneal perforation. This makes it difficult to confidently diagnose the condition. Should be stercoral peritonitis, then the prognosis is poor. We treated a case of intramesenteric perforation of the sigmoid colon with reproperitoneal emphysema. A 79-year-old man was admitted complaining of lower abdominal pain that had developed two days after a barium upper gastrointestinal tract study. On admission, abdominal CT scan revealed massive feces and residual barium in the sigmoid colon ; emphysematous changes were noted in the circumference of the sigmoid colon. Emphysematous changes were also diffusely present up to the pancreatic dorsal area in the retroperitoneal space. An emergency operation was performed under a diagnosis of perforation of the sigmoid colon. On laparotomy, a perforation was present in the mesenteric side of the sigmoid colon ; it was about 4 cm in diameter. Hartmann's operation was performed with resection of the perforated sigmoid colon. The patient was discharged on the 26^th day after surgery. About 4 months after the operation, the patient had surgery to close his stoma. He is currently well.