Sigmoid Colon Perforation Caused by a Foreign Body with Extensive Retroperitoneal and Mediastinal Emphysema—A Case Report and Literature Review—

Abstract

A 77-year-old woman presented to our emergency clinic with fever and abdominal pain. There were no signs of rebound tenderness or muscular defense, but blood tests showed a high inflammatory response. An abdominal computed tomography scan showed retroperitoneal, mediastinal, and subcutaneous emphysema spreading to the left side. Although there was no evidence of intra-abdominal free gas, colon perforation was suspected. Emergency surgery was thus performed. Surgical findings included a foreign body protruding from the sigmoid colon to the abdominal cavity. We observed the descending colon inside out, but there was no other obvious penetration or perforation. We diagnosed the case as perforation caused by a foreign body in the sigmoid colon with retroperitoneal emphysema, and a loop sigmoid colostomy was performed at that site. Postoperative endoscopy revealed a longitudinal ulcer scar in the sigmoid colon. It suggested that the foreign body might have caused mucosal damage in the same area, resulting in various emphysema images.

Colonic perforation with retroperitoneal emphysema is rare and no such cases caused by a foreign body have been reported so far. We report our case of sigmoid colon perforation caused by a foreign body which presented with extensive retroperitoneal and mediastinal emphysema without intra-abdominal free gas.