Massive Retroperitoneal Emphysema Caused by the Stercoral Perforation of the Sigmoid Colon: Report of a Case

Yasushi Hashimoto, Yoshihiro Sakashita, Michio Takamura, Hiroshi Iwako, Yusuke Watadani, Norifumi Shigemoto and Keishi Kin

Department of Surgery, Oda Municipal Hospital

Colon perforation usually occurs into the intraabdominal space and causes generalized peritonitis, requiring surgery. Few cases have been reported of penetration of the mesenterium resulting in a favorable outcome. We report a case of stercoral perforation of the sigmoid colon accompanying pneumoretroperitoneum, pneumomediastinum, subcutaneous emphysema, and intraabdominal free air. A 78-year-old woman admitted for sudden-onset lower abdominal pain, showed muscle guarding and crepitance in the lower abdomen upon abdominal examination. Abdominal CT showed massive pneumoretroperitoneum, pneumomediastinum, subcutaneous emphysema, and intraabdominal free air. Based on a preoperative diagnosis of perforation of the lower gastrointestinal tract, we undertook emergency surgery. A 30 mm perforation of the sigmoid colon was found and the mesentery of the sigmoid colon was diffusely expanded by air. Sigmoid colostomy and drainage of the retroperitoneal space were successful. We conclusively diagnosed stercoral penetration of the sigmoid colon into the mesocolon. The patient suffered complications of MRSA enteritis and retroperitoneal abscess, and died of renal failure on postoperative day 41. Such stercoral perforation of the sigmoid colon accompanied by the clinical presentations of emphysematous change and intraabdominal free air, which perforated both sides of the intraabdominal and retroperitoneal space, is extremely rare.

Key words
stercoral perforation of the sigmoid colon, penetration into the mesocolon, pneumoretroperitoneum

Reprint requests
Yasushi Hashimoto Department of Surgery, Oda Municipal Hospital
1428-3 Yoshinaga, Oda-cho, Oda, 694-0063 JAPAN

Accepted
November 30, 2004

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