RESUMO
BACKGROUND: With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. CASE PRESENTATION: A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. CONCLUSIONS: Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.
Assuntos
COVID-19 , Perfuração Intestinal , Enfisema Mediastínico , Retropneumoperitônio , SARS-CoV-2 , Humanos , COVID-19/complicações , Feminino , Idoso , Perfuração Intestinal/virologia , Perfuração Intestinal/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Retropneumoperitônio/etiologia , Retropneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management. CASE PRESENTATION: A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission. CONCLUSIONS: This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.
Assuntos
Diabetes Mellitus Tipo 2 , Diverticulite , Perfuração Intestinal , Enfisema Mediastínico , Peritonite , Pneumoperitônio , Retropneumoperitônio , Humanos , Feminino , Idoso , Retropneumoperitônio/etiologia , Retropneumoperitônio/complicações , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Diabetes Mellitus Tipo 2/complicações , Peritonite/diagnóstico , Perfuração Intestinal/cirurgiaAssuntos
Cistite , Enfisema , Pneumoperitônio , Retropneumoperitônio , Humanos , Retropneumoperitônio/diagnóstico por imagem , Retropneumoperitônio/etiologia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Cistite/diagnóstico , Cistite/diagnóstico por imagem , Abdome , Injeções Intraperitoneais , Enfisema/complicações , Enfisema/diagnóstico por imagemAssuntos
Diverticulite , Enfisema Mediastínico , Pneumopericárdio , Pneumoperitônio , Retropneumoperitônio , Feminino , Humanos , Idoso , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Retropneumoperitônio/diagnóstico por imagem , Retropneumoperitônio/etiologia , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/etiologia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologiaAssuntos
Rim/diagnóstico por imagem , Alvéolos Pulmonares/lesões , Respiração Artificial/efeitos adversos , Retropneumoperitônio/diagnóstico por imagem , Retropneumoperitônio/etiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/diagnóstico por imagem , Adulto , Feminino , Humanos , Alvéolos Pulmonares/diagnóstico por imagem , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologiaRESUMO
We report a case of incarcerated left indirect inguinal hernia in a male child which on exploration revealed the presence of free air and fecal matter containing fluid in the hernial sac. This is the second reported case of the presence of cecal perforation in left Amyand's hernia in pediatric age group and unique in the sense of the form of abnormal anatomy encountered per-operatively.
Assuntos
Hérnia Inguinal/complicações , Perfuração Intestinal/etiologia , Retropneumoperitônio/etiologia , Ceco , Pré-Escolar , Humanos , MasculinoRESUMO
BACKGROUND: Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures. METHODS: A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum". RESULTS: Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases. CONCLUSIONS: Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence.
Assuntos
Enfisema Mediastínico/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Retropneumoperitônio/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Cirurgia Endoscópica Transanal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Enfisema Mediastínico/epidemiologia , Enfisema Mediastínico/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiografia , Retropneumoperitônio/epidemiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/epidemiologia , Enfisema Subcutâneo/etiologiaAssuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Enfisema Mediastínico/etiologia , Pneumopericárdio/etiologia , Pneumoperitônio/etiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologia , Idoso , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Pneumopericárdio/diagnóstico , Pneumopericárdio/terapia , Pneumoperitônio/diagnóstico , Pneumoperitônio/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Retropneumoperitônio/diagnóstico , Retropneumoperitônio/terapia , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/terapiaAssuntos
Discite/complicações , Retropneumoperitônio/etiologia , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Acidose/etiologia , Injúria Renal Aguda/etiologia , Discite/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Retropneumoperitônio/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagemRESUMO
INTRODUCTION: Subcutaneous face and neck emphysema secondary to colonic perforation is a rare complication of colonoscopy. Presentation may be complicated by pneumothorax and/or respiratory distress. Evidence limited to case studies. Therefore, no management consensus of these rarely reported cases exists. METHODS: All cases published on PubMed between 1 January 2000-1 November 2016 reporting subcutaneous face and/or neck emphysema after colonoscopy are included. Management is discussed with trends identified. We report a case of a patient undergoing routine polypectomy who developed subcutaneous emphysema of the face, neck and thorax with a pneumothorax and pneumoretroperitoneum. RESULTS: 37 cases were found (mean age = 64.1 ± 15.09 years). The majority (n = 24) were managed non-operatively. Conservative and operative management had mean inpatient stays of 7.6 ± 4.65 and 19.5 +/- 21.62 days respectively. Sixteen cases had a concomitant pneumothorax with nine (56.3%) requiring decompression. No mortalities occurred. CONCLUSION: An understanding of anatomy heightens awareness of the rare complication of face and/or neck surgical emphysema, secondary to pneumoretroperitoneum and pneumothorax, after perforation of the colon during endoscopy. Management remains controversial with expectant conservative bowel rest with antibiotics and operative intervention described. Conservative management had a shorter inpatient stay and was more common in younger patients.
Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Enfisema Subcutâneo/terapia , Idoso , Colo/lesões , Face , Cabeça , Humanos , Doença Iatrogênica , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Pescoço , Pneumotórax/etiologia , Pneumotórax/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologia , TóraxRESUMO
Colonoscopy is being widely used since the 1980s and is the leading diagnostic procedure for colorectal cancer. For many colorectal diseases, it is also a therapeutic tool. Like many other procedures in Medicine, it has its drawbacks and complications, some of which if not readily diagnosed can represent a serious risk to the patient's health and well-being. We describe a case of colon perforation during diagnostic colonoscopy in a patient, resulting in exuberant pneumoretroperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema, who successfully underwent laparoscopic colonic resection with primary anastomosis. There are only a few cases of combined intraperitoneal and retroperitoneal perforations described in the literature.
Assuntos
Colonoscopia/efeitos adversos , Perfuração Intestinal/etiologia , Enfisema Mediastínico/etiologia , Pneumoperitônio/etiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologia , Idoso , Anastomose Cirúrgica , Colo Sigmoide/cirurgia , Feminino , Humanos , Laparoscopia , Enfisema Mediastínico/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Espaço Retroperitoneal , Retropneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues. CASE REPORT: We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy. CT scans showed a minimal leakage with no abscess. The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach. CONCLUSION: A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively avoiding ileostomy or colostomy. KEY WORDS: Anastomotic leakage, Pneumoretroperitoneum, Stapled Anopexy.
Assuntos
Fístula Anastomótica/terapia , Tratamento Conservador , Hemorroidas/cirurgia , Enfisema Mediastínico/terapia , Complicações Pós-Operatórias/terapia , Retropneumoperitônio/terapia , Grampeamento Cirúrgico/efeitos adversos , Fístula Anastomótica/etiologia , Antibacterianos/uso terapêutico , Terapia Combinada , Humanos , Masculino , Enfisema Mediastínico/etiologia , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Nutrição Parenteral Total , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Complicações Pós-Operatórias/etiologia , Retropneumoperitônio/etiologia , Tomografia Computadorizada por Raios XAssuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Duodenopatias/etiologia , Perfuração Intestinal/etiologia , Enfisema/etiologia , Feminino , Humanos , Enfisema Mediastínico/etiologia , Pessoa de Meia-Idade , Pescoço , Pneumopericárdio/etiologia , Retropneumoperitônio/etiologiaRESUMO
BACKGROUND: Emphysematous cholecystitis is a severe variant of acute cholecystitis caused by anaerobic bacteria. Although intraperitoneal air as a complication has been described in association with emphysematous cholecystitis, pneumoretroperitoneum arising from emphysematous cholecystitis is extremely rare. Herein, we describe a rare case of pneumoretroperitoneum arising from emphysematous cholecystitis that was successfully treated with emergency surgery. CASE PRESENTATION: An 84-year-old male was transported to the Emergency Department of our hospital for acute abdomen. Computed tomography revealed acute cholecystitis accompanied by emphysematous change. Computed tomography also revealed massive pneumoretroperitoneum complicated with pneumobilia and gas in the hepatoduodenal ligament. Clinical findings fulfilled the diagnostic criteria for systemic inflammatory response syndrome and sepsis. Emergency surgery was carried out with a diagnosis of both emphysematous cholecystitis and gastrointestinal perforation. Intraoperative findings revealed acute gangrenous cholecystitis and pneumoretroperitoneum presenting with an odor-free foamy abscess along the loose connective tissue behind the ascending colon and mesocolon. No evidence of gastrointestinal perforation was found during surgery. Therefore, cholecystectomy and lavage drainage were performed. Bacterial culture examination isolated a single species of anaerobe, Klebsiella pneumoniae, which was considered to be the cause of emphysematous cholecystitis, pneumobilia, and pneumoretroperitoneum. CONCLUSIONS: Emphysematous cholecystitis should be considered as a possible cause of pneumoretroperitoneum. The present case is the first report of massive pneumoretroperitoneum extending to the dorsal side of the ascending mesocolon as a complication of emphysematous cholecystitis.
Assuntos
Colecistite Enfisematosa/complicações , Infecções por Klebsiella/complicações , Klebsiella pneumoniae , Retropneumoperitônio/etiologia , Sepse/complicações , Idoso de 80 Anos ou mais , Colecistectomia , Colecistite Enfisematosa/microbiologia , Colecistite Enfisematosa/cirurgia , Humanos , Infecções por Klebsiella/microbiologia , Masculino , Lavagem Peritoneal , Doenças Raras/etiologia , Doenças Raras/cirurgia , Retropneumoperitônio/cirurgia , Sepse/microbiologiaRESUMO
This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.
Assuntos
Doenças do Gato/patologia , Neoplasias Pulmonares/veterinária , Enfisema Mediastínico/veterinária , Pneumopericárdio/veterinária , Pneumotórax/veterinária , Retropneumoperitônio/veterinária , Animais , Gatos , Feminino , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/patologia , Pneumopericárdio/etiologia , Pneumopericárdio/patologia , Pneumotórax/etiologia , Pneumotórax/patologia , Retropneumoperitônio/etiologia , Retropneumoperitônio/patologia , Tomografia Computadorizada por Raios X/veterináriaRESUMO
Multiple endotracheal intubation (ETI) attempts increase the risk of airway-related adverse events. However, little is known about autopsy findings after severe ETI-related complications. We present the detailed pathological findings in a patient with severe ETI-related complications. A 77-year-old obese male suffered cardiopulmonary arrest after choking at a rehabilitation facility. Spontaneous circulation returned after chest compressions and foreign-body removal. After multiple failed direct laryngoscopies, the patient was transferred to our hospital. He had massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum on admission, and died from hypoxic brain injury 15 h later. Autopsy revealed severe oropharyngeal, laryngeal, and left lung lower lobe injury. The likely mechanisms of diffuse emphysema were (1) oropharyngeal injury associated with multiple ETI attempts and excessive ventilation pressures and (2) left lung lower lobe injury associated with chest compressions and other resuscitative procedures. Multiple laryngoscopies can cause severe upper-airway injury, worsen respiratory status, and make ETI more difficult-a vicious circle that can be prevented by limiting ETI attempts. This is particularly important in unfavorable environments, in which backup devices and personnel are not easily obtained. The pathological findings in our patient caution against repeated attempts at ETI during resuscitation.