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Malik S, Harris JE, Vasdev R, Rezcallah AT. Perforated Appendicitis Presenting as a Soft Tissue Infection of the Thigh: An Example of Successful Non-Operative Management. Cureus 2023; 15:e35560. [PMID: 37007349 PMCID: PMC10060116 DOI: 10.7759/cureus.35560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Perforated appendicitis is a rare but serious clinical scenario typically requiring urgent surgical intervention. Herein, we discuss the case of a 62-year-old woman with COVID-19 and ruptured retrocecal appendicitis presenting as a right lower extremity soft tissue infection that was successfully managed using non-operative measures. This unique case illustrates the feasibility of conservative care - rather than urgent surgical intervention - in the treatment of an atypical presentation of complicated appendicitis in a high-risk patient.
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2
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Montuori M, Famularo S, Santurro L, Lo Bianco G, Giani A, Uggeri F, Gianotti LV. Retroperitoneal abscess from perforated acute appendicitis: a diagnostic challenge. Chirurgia (Bucur) 2020; 32. [DOI: 10.23736/s0394-9508.18.04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
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3
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Papanikolas M, Kim TJ, Mackenzie S. Hindquarter amputation resulting from a perforated retroperitoneal appendicitis: a rare case. ANZ J Surg 2019; 90:E46-E47. [PMID: 31069950 DOI: 10.1111/ans.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Papanikolas
- Department of Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Tae-Jun Kim
- Department of Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Scott Mackenzie
- Department of Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
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Mallia AJ, Ashwood N, Arealis G, Galanopoulos I. Retroperitoneal abscess: an extra-abdominal manifestation. BMJ Case Rep 2015; 2015:bcr-2014-207437. [PMID: 25576509 DOI: 10.1136/bcr-2014-207437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
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Affiliation(s)
- Alvin James Mallia
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - George Arealis
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Ilias Galanopoulos
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
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5
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Dalbem CS, Nunes TF, Machado MDSS, Goldman SM. Pneumomediastinum and pneumoretroperitoneum: an extremely rare presentation of acute appendicitis. BMJ Case Rep 2015; 2015:bcr-2014-207255. [PMID: 25576508 DOI: 10.1136/bcr-2014-207255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old woman presented with abdominal pain for 12 days. On examination, the abdomen was slightly distended and painful to palpation in the right flank. Subsequent abdominal imaging showed inflammation in the right iliac fossa, retroperitoneal air pockets with inflammation, and signs of pneumomediastinum. Exploratory laparotomy revealed a perforated retrocaecal appendix with abscess extending to the retroperitoneum. Surgical intervention involved a right hemicolectomy followed by end-to-side anastomosis of the ileum to the transverse colon. Histopathological examination of the resected specimen revealed intense inflammation of the caecum and no signs of malignancy. The patient was discharged in good condition 54 days after surgery.
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Affiliation(s)
- Caroline Sauter Dalbem
- Department of General Surgery, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Thiago Franchi Nunes
- Department of Clinical Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Park HC, Kim BS, Lee K, Kim MJ, Lee BH. Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack. Int J Colorectal Dis 2014; 29:1217-22. [PMID: 24980689 DOI: 10.1007/s00384-014-1941-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Most patients with acute right colonic uncomplicated diverticulitis can be managed conservatively. The aim of this study was to assess the clinical and radiologic risk factors for recurrence in patients with right colonic uncomplicated diverticulitis. METHODS The present survey included 469 patients who were successfully managed conservatively for the first episode of right colonic uncomplicated diverticulitis between 2002 and 2012 in a referral center, and records were reviewed from collected data. Patients were divided into two groups: a nonrecurrent and a recurrent group. The clinical and radiologic features of all patients were analyzed to identify possible risk factors for recurrence. The Kaplan-Meier method and Cox regression were used. RESULTS Seventy-four (15.8 %) patients had recurrence, and 15 (3.2 %) received surgery at recurrence within a median follow-up of 59 months. The mean recurrence interval after the first attack was 29 months. In univariate and multivariate analyses, risk factors for recurrence were confirmed multiple diverticula (relative risk [RR], 2.62; 95 % confidence interval [CI], 1.56-4.40) and intraperitoneally located diverticulitis (RR, 3.73; 95 % CI, 2.13-6.52). Of 66 patients with two risk factors, 36 (54.5 %) had recurrence and 10 (15.2 %) received surgery at recurrence. CONCLUSIONS In patients with right colonic uncomplicated diverticulitis who have multiple diverticula and intraperitoneally located diverticulitis, the possibility of recurrence and surgical rate are high. Poor outcome may be cautioned in these patients.
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Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 431-070, Republic of Korea
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7
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Mekhail P, Saklani A, Philobos M, Masoud A. Thigh subcutaneous emphysema: is that a clear indication for thigh exploration? J Surg Case Rep 2011; 2011:1. [PMID: 24950556 PMCID: PMC3649209 DOI: 10.1093/jscr/2011.2.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thigh subcutaneous emphysema is an usual orthopaedic presentation normally associated with musculoskeletal problems or penetrating wounds. But, sometimes it can be related to abdominal pathology. We present a case of subcutaneous emphysema of the thigh secondary to para-caecal abscess.
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Affiliation(s)
- P Mekhail
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - A Saklani
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - M Philobos
- Prince Charles Hospital, Merthyr Tydfil, UK
| | - Ag Masoud
- Prince Charles Hospital, Merthyr Tydfil, UK
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Choi SB, Han HJ, Kim WB, Song TJ, Choi SY. A case of a recurrent iliopsoas abscess masking a complicated appendicitis successfully treated by a laparoscopic approach. Surg Laparosc Endosc Percutan Tech 2010; 20:e69-72. [PMID: 20393325 DOI: 10.1097/sle.0b013e3181d69695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Iliopsoas abscesses can be caused by a secondary adjacent infectious source in the bowel. Complicated retroperitoneal abscesses involving the iliopsoas muscle and the lateral abdominal wall can develop as a serious complication of a perforated acute appendicitis. A 73-year-old man with a history of recurrent iliopsoas abscess was referred to our clinic. He had earlier been treated for recurrent right iliopsoas abscess by a percutaneous catheter and operative drainage and antibiotics in another hospital 3 times for 6 years at 2 or 3 year intervals. At the fourth episode, the abscess was proven to be caused by perforated appendicitis on laparoscopic exploration. The main drainage procedure of the abscess, as well as the appendectomy, was performed through a laparoscopic approach.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea.
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9
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Jones GH, Kalaher HR. Diverticular disease presenting as subcutaneous emphysema of the thigh. BMJ Case Rep 2009; 2009:bcr01.2009.1465. [PMID: 21687014 DOI: 10.1136/bcr.01.2009.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A normally fit and well 79-year-old lady presented acutely confused and shocked after a few months history of atypical left-sided back and thigh pain. She was unable to tolerate movement of her left leg and soft tissue crepitus was palpable over her thigh. Emergency incision and drainage of the leg was performed with intraoperative swabs growing Streptococcusmilleri and coliforms. Postoperatively, in the Intensive Care Unit (ICU) deep faecal contamination of the wound was noted. Contrast imaging revealed severe diverticular disease and colocutaneous fistula. Abdominal examination was unremarkable throughout her admission and initial CT scan had not revealed the underlying pathology. A defunctioning colostomy was fashioned and after a prolonged period of rehabilitation the patient returned to being functionally independent.
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Affiliation(s)
- Gareth Huw Jones
- Mersey Deanery, 7 Kenwick Close, Great Sutton, Ellesmere Port, Cheshire, CH66 2HY, UK
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10
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Moussi A, Jarboui S, Krichen A, Jerraya H, Abdesselem MM, Zaouche A. [Retroperitoneal gangrene from a perforated retrocecal appendicitis]. ACTA ACUST UNITED AC 2008; 145:603-4. [PMID: 19106894 DOI: 10.1016/s0021-7697(08)74694-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A Moussi
- Service de chirurgie générale "A", hôpital Charles Nicolle - Tunis, Tunisie.
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Kobayashi S, Negoro K, Uchida K, Kokubo Y, Takeno K, Yayama T, Katayama K, Yamaguchi A, Baba H. Successful treatment of nonclostridial gas gangrene extending from retroperitoneum to thigh associated with occult cecal cancer. J Orthop Sci 2007; 12:585-91. [PMID: 18040642 DOI: 10.1007/s00776-007-1172-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/20/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Shigeru Kobayashi
- Department of Orthopaedics, Fukui University School of Medicine, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
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12
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Retroperitoneal abscess resulting from perforated acute appendicitis: analysis of its management and outcome. Surg Today 2007; 37:762-7. [PMID: 17713730 DOI: 10.1007/s00595-006-3481-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 12/08/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. MATERIALS AND METHODS In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. RESULTS Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. CONCLUSION The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospitalz, No.2, Yuh-Der Road, Taichung 404, Taiwan
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Yildiz M, Karakayali AS, Ozer S, Ozer H, Demir A, Kaptanoglu B. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report. World J Gastroenterol 2007; 13:3631-3. [PMID: 17659716 PMCID: PMC4146805 DOI: 10.3748/wjg.v13.i26.3631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.
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Affiliation(s)
- Mustafa Yildiz
- Department of General Surgery, Ministry of Health Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey.
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de Vries L, Knoepfli AS, Konstantinidis P, Charbonney E. Subcutaneous emphysema: a rare manifestation of a perforated diverticulitis in a patent inguinal canal. Hernia 2006; 11:261-3. [PMID: 17136307 DOI: 10.1007/s10029-006-0172-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
Patients with complicated diverticulitis rarely present with extraperitoneal manifestations but the manifestation of subcutaneous emphysema appears even more seldom. We present the case of a patient with a history of diabetes and immunosuppression, who was admitted with sepsis in association with cellulitis and subcutaneous emphysema of the left groin. The absence of peritonism due to corticosteroid treatment, a history of a recent fall with an ilio- and ischio-pubic fracture and subcutaneous emphysema led to a delay in the diagnosis. The final diagnosis was a perforated diverticulitis in a patent inguinal canal, which was only revealed after surgery. The various complications of diverticulitis, including extraperitoneal manifestations, and associated microorganisms implicated in cellulitis and subcutaneous emphysema are briefly reviewed.
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MESH Headings
- Aged, 80 and over
- Colectomy/methods
- Colon, Sigmoid
- Diagnosis, Differential
- Diverticulitis, Colonic/complications
- Diverticulitis, Colonic/diagnosis
- Diverticulitis, Colonic/surgery
- Fatal Outcome
- Female
- Hernia, Inguinal/complications
- Hernia, Inguinal/diagnosis
- Hernia, Inguinal/surgery
- Humans
- Inguinal Canal
- Laparotomy
- Palpation
- Rupture, Spontaneous
- Subcutaneous Emphysema/diagnosis
- Subcutaneous Emphysema/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- Lambert de Vries
- Internal Medicine Department, University Hospital Geneva, Rue Micheli-Du-Crest 24, 1211, Geneva 14, Switzerland
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15
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease. World J Gastroenterol 2006; 12:496-9. [PMID: 16489659 PMCID: PMC4066078 DOI: 10.3748/wjg.v12.i3.496] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, China
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16
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Sharma SB, Gupta V, Sharma SC. Acute appendicitis presenting as thigh abscess in a child: a case report. Pediatr Surg Int 2005; 21:298-300. [PMID: 15756560 DOI: 10.1007/s00383-004-1356-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2003] [Indexed: 02/06/2023]
Abstract
A case of retrocecal appendicitis is described in a 6-year-old male child who presented with thigh abscess. The presence of a positive psoas stretch test, feculent discharge, an enteric growth on bacteriological examination, and intraabdominal fluid collection on abdominal ultrasound provided clues to the presence of an intraabdominal source of sepsis. Laparotomy revealed a perforated retrocecal appendix with surrounding collection communicating into the thigh. Appendectomy with drainage of retroperitoneal and thigh collections under adequate antibiotic coverage resulted in a satisfactory recovery. We describe our experience with the present case and discuss the pertinent literature.
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Affiliation(s)
- S B Sharma
- Department of Neonatal and Pediatric Surgery, SMS Medical College, S.P. Mother and Child Health Institute, Jaipur, 302004 Rajasthan, India
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17
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Ríos Zambudio A, Piñero Madrona A, González Sánchez F, Parrilla Paricio P. [Subcutaneous emphysema of the lower limb as presenting manifestation of colon dehiscence]. Rev Clin Esp 2002; 202:571-2. [PMID: 12361563 DOI: 10.1016/s0014-2565(02)71149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Arenal JJ, Velasco MJ, Piqueras JM, Simal F. [Gas gangrene of the thigh secondary to Crohns disease of the sigmoid colon]. Med Clin (Barc) 2002; 118:397. [PMID: 11940399 DOI: 10.1016/s0025-7753(02)72396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tramoni G, Mohammedi I, Peguet O, Petit P. [Thigh cellulitis: atypical presentation of intra-abdominal infection]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:803-6. [PMID: 11759323 DOI: 10.1016/s0750-7658(01)00488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The initial clinical presentation of intraabdominal disease can be an extraabdominal location. We report three cases of patients admitted to our intensive care unit because of a severe soft tissue infection of the lower extremity. Systematic research of the primitive source by using computed tomography (CT) scan allows us to find perforation of the gastrointestinal tract. Despite an unusual presentation, a high index of suspicion for lower intestine perforation must always be considered in face of a patient presenting with a spontaneous thigh cellulitis. Immediate radical debridement, appropriate antibiotics, and intensive care support are critical to control these life-threatening infections.
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Affiliation(s)
- G Tramoni
- Service de réanimation polyvalente, pavillon G, hôpital Edouard-Herriot, place d'Arsonval, 69003 Lyon, France
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20
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Abstract
Leg pain may be a presenting symptom of intra-abdominal disease. I report a case of subcutaneous emphysema of the thigh that was a complication of diverticular perforation and abscess formation. Healthy leg muscle was found at operation, showing that myonecrosis need not necessarily be present even with finding of extensive gas accumulation.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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21
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Jager GJ, Joosten F, vd Berkmortel FW, Salemans JM. Subcutaneous emphysema of the lower extremity secondary to a perforated esophageal carcinoma. ABDOMINAL IMAGING 1995; 20:23-5. [PMID: 7894292 DOI: 10.1007/bf00199637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The psoas muscle is a potential pathway of disease from the mediastinum to the leg. We describe a case of subcutaneous emphysema of the lower extremity due to a perforated esophageal carcinoma in a 58-year-old man.
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Affiliation(s)
- G J Jager
- Department of Diagnostic Radiology, University Hospital St Radboud, Nijmegen, The Netherlands
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22
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Affiliation(s)
- L C Moses
- Pulmonary/Critical Care Division, Medical College of Virginia/McGuire VA Medical Center, Richmond
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23
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Jager GJ, Rijssen HV, Lamers JJ. Subcutaneous emphysema of the lower extremity of abdominal origin. GASTROINTESTINAL RADIOLOGY 1990; 15:253-8. [PMID: 2341001 DOI: 10.1007/bf01888788] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Three cases of subcutaneous emphysema of the lower extremity due to abdominal disease are reported. These were due to (a) perforation of the sigmoid, (b) perirectal abscess, and (c) non-traumatic metastatic gas gangrene due to emphysematous cholecystitis. The mechanisms and anatomical pathways are discussed.
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Affiliation(s)
- G J Jager
- Department of Radiology, De Wever Hospital Heerlen, The Netherlands
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