A Case of Atypical Cryptogenic Retroperitoneal Emphysema

Abstract

A 62-year-old woman complaining of a right lower quadrant tumor was found to have an 8-cm diameter gas collection in the retroperitoneal space, when fluoroscopic study done with a suspicion of communication with the gastrointestinal tract disclosed no recognizable findings including fistula formation. As she had no symptoms such as abdominal pain and no abnormal findings were reported on blood examination, we decided to follow her clinical course. Six months later, gas shadow increased in size and she developed a sense of oppression in the abdomen. Exploratory laparotomy was thus performed. An encapsulated and well demarcated tumor 15 cm in diameter was identified in the right retroperitoneal space, for that drainage was performed. It was found that no liquid component was present within the tumor and only gas component was collected within it. An intraabdominal survey disclosed no findings suggestive of communication with the digestive organs. After the operation, recurrence at the same area occurred and CT-guided drainage was carried out. Thereafter no recurrence has occurred for 15 months up to now.
We consider percutaneous drainage to be a beneficial therapy for retroperitoneal emphysema without accompanying by fiver and inflammation. The paper deals with our experience with a case of atypical cryptogenic retroperitoneal emphysema including the clinical course and imaging findings, together with a review of the literature.