Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review
Background: Mediastinal and subcutaneous emphysema usually result from spontaneous rupture of the alveolar wall. We present an educational case of subcutaneous, mediastinal, and retroperitoneal emphysema discovered during a routine medical check-up resulting from an asymptomatic perforation of the s...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Respiratory Medicine Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007125000656 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849421328072835072 |
|---|---|
| author | Daichi Setoguchi Naoki Iwanaga Kotaro Nema Tomoya Hagiwara Kotaro Hayashida Koki Yamashita Tatsuro Hirayama Masataka Yoshida Kazuaki Takeda Shotaro Ide Masato Tashiro Takahiro Takazono Masachika Kitajima Noriho Sakamoto Koichi Izumikawa Katsunori Yanagihara Keiji Inoue Hiroshi Mukae |
| author_facet | Daichi Setoguchi Naoki Iwanaga Kotaro Nema Tomoya Hagiwara Kotaro Hayashida Koki Yamashita Tatsuro Hirayama Masataka Yoshida Kazuaki Takeda Shotaro Ide Masato Tashiro Takahiro Takazono Masachika Kitajima Noriho Sakamoto Koichi Izumikawa Katsunori Yanagihara Keiji Inoue Hiroshi Mukae |
| author_sort | Daichi Setoguchi |
| collection | DOAJ |
| description | Background: Mediastinal and subcutaneous emphysema usually result from spontaneous rupture of the alveolar wall. We present an educational case of subcutaneous, mediastinal, and retroperitoneal emphysema discovered during a routine medical check-up resulting from an asymptomatic perforation of the sigmoid diverticulum. Case presentation: A 66-year-old man presented to our hospital for his health check-up. A chest X-ray revealed mediastinal emphysema during a physical examination. The patient had no subjective symptoms, fever, or hemodynamic instability. Physical examination revealed a snow grip sensation in the anterior neck but no abdominal tenderness. Blood tests showed an elevated inflammatory response, and a plain chest computed tomography scan revealed subcutaneous emphysema around the neck, as well as mediastinal and retroperitoneal emphysema. The patient was then admitted to the hospital and the patient was treated conservatively. On Day 7 post-admission, the emphysema was mildly relieved. However, on Day 10, the patient developed intestinal obstruction caused by barium. Colonoscopy revealed sigmoid colon perforation. On Day 11, partial resection of the sigmoid colon via laparotomy and colostomy (Hartmann operation) was performed. Postoperative pathology revealed a perforation of the sigmoid colon, which was confirmed to be induced by diverticulitis, as multiple diverticula were simultaneously found in the sigmoid colon. Conclusions: Even in the absence of abdominal symptoms, retroperitoneal emphysema may develop due to perforation of the sigmoid colon. Therefore, if retroperitoneal emphysema is combined with mediastinal emphysema, evaluation, including abdominal CT, should be performed to identify the cause of emphysema. |
| format | Article |
| id | doaj-art-7918af4479c04950be80cb00eb6fd155 |
| institution | Kabale University |
| issn | 2213-0071 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj-art-7918af4479c04950be80cb00eb6fd1552025-08-20T03:31:30ZengElsevierRespiratory Medicine Case Reports2213-00712025-01-015610222910.1016/j.rmcr.2025.102229Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature reviewDaichi Setoguchi0Naoki Iwanaga1Kotaro Nema2Tomoya Hagiwara3Kotaro Hayashida4Koki Yamashita5Tatsuro Hirayama6Masataka Yoshida7Kazuaki Takeda8Shotaro Ide9Masato Tashiro10Takahiro Takazono11Masachika Kitajima12Noriho Sakamoto13Koichi Izumikawa14Katsunori Yanagihara15Keiji Inoue16Hiroshi Mukae17Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan; Corresponding author. Department of Respiratory Medicine, Nagasaki University Hospital, 1Sakamoto, Nagasaki City, 852-8501, Japan.Department of Respiratory Medicine, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Surgery, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Surgery, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Pharmacotherapeutics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, JapanInfectious Diseases Experts Training Center, Nagasaki University Hospital, Nagasaki, JapanDepartment of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanDepartment of Surgery, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, JapanDepartment of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanDepartment of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, JapanDepartment of Surgery, Nagasaki Gotochuoh Hospital, Nagasaki, JapanDepartment of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, JapanBackground: Mediastinal and subcutaneous emphysema usually result from spontaneous rupture of the alveolar wall. We present an educational case of subcutaneous, mediastinal, and retroperitoneal emphysema discovered during a routine medical check-up resulting from an asymptomatic perforation of the sigmoid diverticulum. Case presentation: A 66-year-old man presented to our hospital for his health check-up. A chest X-ray revealed mediastinal emphysema during a physical examination. The patient had no subjective symptoms, fever, or hemodynamic instability. Physical examination revealed a snow grip sensation in the anterior neck but no abdominal tenderness. Blood tests showed an elevated inflammatory response, and a plain chest computed tomography scan revealed subcutaneous emphysema around the neck, as well as mediastinal and retroperitoneal emphysema. The patient was then admitted to the hospital and the patient was treated conservatively. On Day 7 post-admission, the emphysema was mildly relieved. However, on Day 10, the patient developed intestinal obstruction caused by barium. Colonoscopy revealed sigmoid colon perforation. On Day 11, partial resection of the sigmoid colon via laparotomy and colostomy (Hartmann operation) was performed. Postoperative pathology revealed a perforation of the sigmoid colon, which was confirmed to be induced by diverticulitis, as multiple diverticula were simultaneously found in the sigmoid colon. Conclusions: Even in the absence of abdominal symptoms, retroperitoneal emphysema may develop due to perforation of the sigmoid colon. Therefore, if retroperitoneal emphysema is combined with mediastinal emphysema, evaluation, including abdominal CT, should be performed to identify the cause of emphysema.http://www.sciencedirect.com/science/article/pii/S2213007125000656Subcutaneous emphysemaMediastinal emphysemaRetroperitoneal emphysemaPerforation of sigmoid diverticulum |
| spellingShingle | Daichi Setoguchi Naoki Iwanaga Kotaro Nema Tomoya Hagiwara Kotaro Hayashida Koki Yamashita Tatsuro Hirayama Masataka Yoshida Kazuaki Takeda Shotaro Ide Masato Tashiro Takahiro Takazono Masachika Kitajima Noriho Sakamoto Koichi Izumikawa Katsunori Yanagihara Keiji Inoue Hiroshi Mukae Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review Respiratory Medicine Case Reports Subcutaneous emphysema Mediastinal emphysema Retroperitoneal emphysema Perforation of sigmoid diverticulum |
| title | Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review |
| title_full | Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review |
| title_fullStr | Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review |
| title_full_unstemmed | Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review |
| title_short | Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review |
| title_sort | asymptomatic sigmoid diverticulum perforation induced subcutaneous mediastinal and retroperitoneal emphysema a case report and literature review |
| topic | Subcutaneous emphysema Mediastinal emphysema Retroperitoneal emphysema Perforation of sigmoid diverticulum |
| url | http://www.sciencedirect.com/science/article/pii/S2213007125000656 |
| work_keys_str_mv | AT daichisetoguchi asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT naokiiwanaga asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT kotaronema asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT tomoyahagiwara asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT kotarohayashida asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT kokiyamashita asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT tatsurohirayama asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT masatakayoshida asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT kazuakitakeda asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT shotaroide asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT masatotashiro asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT takahirotakazono asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT masachikakitajima asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT norihosakamoto asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT koichiizumikawa asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT katsunoriyanagihara asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT keijiinoue asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview AT hiroshimukae asymptomaticsigmoiddiverticulumperforationinducedsubcutaneousmediastinalandretroperitonealemphysemaacasereportandliteraturereview |