A Case of Sigmoid Diverticulum Penetration Discovered due to Subcutaneous Emphysema in the Chest

Abstract

A 78-year-old woman was presented to the hospital with a chief complaint of consciousness disturbance. The patient was hospitalized for dehydration and cognitive decline treatment. Neurological symptoms of microscopic polyangiitis were diagnosed as the cause of cognitive decline, and steroid pulse therapy was performed. During the steroid reduction course, extensive subcutaneous emphysema was observed mainly on the left side of the chest, extending from the left neck to the lower left abdomen. The only physical finding was extensive subcutaneous emphysema without abdominal symptoms. Computed tomography showed a large amount of emphysema mainly on the left lateral side of the chest, which was connected to the left neck and left pelvic retroperitoneum. No free intraperitoneal air was observed, but small air bubbles were suspected in the mesosigmoid. Based on the findings, mesosigmoid penetration was suspected, and an emergency exploratory laparotomy was performed. Based on the intraoperative findings, the patient was diagnosed with mesosigmoid penetration, and Hartmann's operation was performed. Histopathological findings indicated diverticulum perforation. We report a case of mesosigmoid penetration without evidence of peritonitis, which was discovered due to extensive subcutaneous emphysema.