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To L, Kim TJ, Lendzion RJ, Gilmore AJ. Unfortunate case of left leg abscess secondary to a retroperitoneal perforation of sigmoid diverticulitis. ANZ J Surg 2021; 92:1257-1258. [PMID: 34652046 DOI: 10.1111/ans.17261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lilian To
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Tae-Jun Kim
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Rebecca J Lendzion
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Andrew J Gilmore
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, New South Wales, Australia.,Department of Colorectal Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia
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Kuhn G, Lekeufack JB, Chilcott M, Mbaidjol Z. Subcutaneous Emphysema Caused by an Extraperitoneal Diverticulum Perforation: Description of Two Rare Cases and Review of the Literature. Case Rep Surg 2018; 2018:3030869. [PMID: 30155336 PMCID: PMC6091281 DOI: 10.1155/2018/3030869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/01/2018] [Indexed: 01/19/2023] Open
Abstract
The onset of colon diverticular disease is a frequent event, with a prevalence that increases with age. Amongst possible complications, free peritoneal perforation with abscess formation may occur. We herein describe two rare presentations of an extraperitoneal sigmoid diverticulum perforation. Our first patient, an 89-year-old female with no signs of distress, developed a subcutaneous abscess and emphysema in an incisional hernia following an appendectomy through a McBurney incision. The second patient, an 82-year-old female, was in general distress at the time of her admission and had a more advanced infection following the occurrence of a sigmoid perforation in a hernial sac. Complicated diverticulitis has a known course and evolution, but with an extraperitoneal presentation, this etiology is not expected. A computed tomography (CT) scan should be completed if the patient is hemodynamically stable, and wide debridement should be performed. Subcutaneous emphysema with an acute abdomen may be a sign of sigmoid perforation. Clinicians should keep this etiology in mind, regardless of the initial presentation.
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Affiliation(s)
- Gael Kuhn
- Hôpital Fribourgeois Riaz, Rue de l'Hôpital 9, Case Postale 70, Riaz, 1632 Fribourg, Switzerland
| | - Jean Bruno Lekeufack
- Hôpital Fribourgeois Riaz, Rue de l'Hôpital 9, Case Postale 70, Riaz, 1632 Fribourg, Switzerland
| | - Michael Chilcott
- Hôpital Fribourgeois Riaz, Rue de l'Hôpital 9, Case Postale 70, Riaz, 1632 Fribourg, Switzerland
| | - Zacharia Mbaidjol
- Hôpital Fribourgeois Riaz, Rue de l'Hôpital 9, Case Postale 70, Riaz, 1632 Fribourg, Switzerland
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Pelvic primary staphylococcal infection presenting as a thigh abscess. Case Rep Surg 2013; 2013:539737. [PMID: 23607037 PMCID: PMC3628494 DOI: 10.1155/2013/539737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 12/27/2022] Open
Abstract
Intra-abdominal disease can present as an extra-abdominal abscess and can follow several routes, including the greater sciatic foramen, obturator foramen, femoral canal, pelvic outlet, and inguinal canal. Nerves and vessels can also serve as a route out of the abdomen. The psoas muscle extends from the twelfth thoracic and fifth lower lumbar vertebrae to the lesser trochanter of the femur, which means that disease in this muscle group can migrate along the muscle, out of the abdomen, and present as a thigh abscess. We present a case of a primary pelvic staphylococcal infection presenting as a thigh abscess. The patient was a 60-year-old man who presented with left posterior thigh pain and fever. Physical examination revealed a diffusely swollen left thigh with overlying erythematous, shiny, and tense skin. X-rays revealed no significant soft tissue lesions, ultrasound was suggestive of an inflammatory process, and MRI showed inflammatory changes along the left hemipelvis and thigh involving the iliacus muscle group, left gluteal region, and obturator internus muscle. The abscess was drained passively via two incisions in the posterior left thigh, releasing large amounts of purulent discharge. Subsequent bacterial culture revealed profuse growth of Staphylococcus aureus. The patient recovered uneventfully except for a moderate fever on the third postoperative day.
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Thakral R, Debanath UK, Damodaran T, Prasad CVR. Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion. Ir J Med Sci 2009; 180:333-6. [PMID: 19588225 DOI: 10.1007/s11845-009-0380-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 06/09/2009] [Indexed: 11/25/2022]
Abstract
Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.
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Affiliation(s)
- R Thakral
- Department of Trauma and Orthopaedics, Merlin Park Regional Hospital, Galway, Ireland.
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Kompanje EJO, van der Hoven B. "Flatus profuse present in the muscles": subcutaneous emphysema of the lower abdominal wall and thighs, described in 1593 by fabricius hildanus. Surg Infect (Larchmt) 2009; 10:349-51. [PMID: 19538099 DOI: 10.1089/sur.2008.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 1598 and 1641, 600 medical and surgical observations made by the famous German surgeon Guilhelmius Fabricius Hildanus (1560-1634) were published in his Observationum et curationum chirurgicarum centuriae I-VI. METHODS Review of the extant document for evidence of infection-related cases. RESULTS One of the case reports, published as Observatio LXX in the fifth Centuria, bears the title (in translation) Of flatus, profuse present in the muscles. This case report probably is the earliest accurate description of subcutaneous emphysema of the lower abdomen and thighs secondary to a retroperitoneal abscess. CONCLUSION The presence of gas in the superficial tissues of the abdominal wall or thighs is a rare feature and can be a late sign of an otherwise-obscure intra-abdominal abscess with gas-producing bacteria. Fabricius Hildanus almost certainly was the first to document this rare feature in 1593, and judged it important enough to describe in his Centuriae.
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Affiliation(s)
- Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, The Netherlands.
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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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Rangel-Villalobos E, Marín-Lapeira Y, Parra-García B, Fernández-Usagre FJ. Enfisema subcutáneo como signo de perforación de colon. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Chankowsky J, Dupuis P, Gordon PH. Sigmoid diverticulitis presenting as a lower extremity abscess: report of a case. Dis Colon Rectum 2001; 44:1711-3. [PMID: 11711748 DOI: 10.1007/bf02234396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J Chankowsky
- Department of Diagnostic Radiology, the Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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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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Abstract
Abscesses of the thigh are rare and, although easily diagnosed, their cause is often obscure. We present two cases of thigh abscesses which resulted from the extension of intraabdominal sepsis. A review of the literature reveals only 46 previously reported cases. The underlying pathologic abnormality is usually a retroperitoneal perforation of a colorectal neoplasm or diverticular disease, whereas origin from the small bowel or appendix is distinctly less common. Routes of extension of infection into the thigh can be either direct, through the subcutaneous tissues, or through naturally occurring defects in the abdominal wall. These include: (1) along the psoas muscle deep to the inguinal ligament; (2) through the femoral canal; (3) by way of the obturator foramen; and (4) through the sacrosciatic notch. The two cases presented are unusual in that they both followed radical cystectomy with lymph node dissection, which opens up these natural avenues to the spread of intraabdominal infection. The overall mortality in the literature is high (53 percent), but recognition of an abdominal source and appropriate treatment combined with local drainage of the thigh abscess appears to improve survival.
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Waizbard E, Michowitz M, Baratz M, Papo J, Stavorovsky M. Unusual presentation of carcinoma of the vermiform appendix: a report of two cases. J Surg Oncol 1984; 25:263-7. [PMID: 6325820 DOI: 10.1002/jso.2930250409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Two unusual presentations of perforated mucoid adenocarcinoma of the appendix are described. One patient presented with a large periappendicular abscess that extended into the gluteal region, the other with a retroperitoneal abscess and abscesses in the right flank and groin. Recognition of the source of the abscess may be difficult but is essential for the prevention and elimination of the sepsis which may be life-threatening. The presence of mucin in the drained pus is highly suggestive for perforated bowel carcinoma. A high index of suspicion and the performance of prompt diagnostic procedures may bring early surgical treatment and better results.
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Seaman WB. X-ray casebook. The case of the bubbly leg. HOSPITAL PRACTICE (OFFICE ED.) 1983; 18:41-2. [PMID: 6404762 DOI: 10.1080/21548331.1983.11702488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Two unusual presentations of carcinoma of the right colon are described. One of the two patients presented with a right gluteal abscess and the other presented with a colocutaneous fistula to the anterior abdominal wall at the site of a previous appendectomy scar. Despite extensive local tumor invasion of adjacent structures in both cases, all the regional lymph nodes were free of cancer and the tumors were of low-grade malignancy. A review of the literature indicates that bulky colonic tumors with extensive local invasion and negative mesenteric lymph nodes have a relatively good prognosis if adequate resection is performed.
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Lipsit ER, Lewicki AM. Subcutaneous emphysema of the abdominal wall from diverticulitis with necrotizing fasciitis. GASTROINTESTINAL RADIOLOGY 1979; 4:89-92. [PMID: 153870 DOI: 10.1007/bf01887503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The case history of a patient with subcutaneous emphysema of the abdomen from sigmoid diverticulitis is presented. The mechanisms for developing abdominal wall emphysema are reviewed. Thus when the gas originates from the gastrointestinal tract, mechanical factors are mainly responsible for this phenomenon. These inculde a direct communication through a colonocutaneous fistula. Gas may, however, also be spread into the abdominal wall by high intraintestinal pressures. Infection with gas-producing organisms may be associated with subcutaneous emphysema. This is particularly true when the emphysema develops 48 h or longer after onset of symptoms. Infection, however, is not the major cause for gas in these tissues.
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Mair WS, McAdam WA, Lee PW, Jepson K, Goligher JC. Carcinoma of the large bowel presenting as a subcutaneous abscess of the thigh : a report of 4 cases. Br J Surg 1977; 64:205-9. [PMID: 890269 DOI: 10.1002/bjs.1800640317] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Four cases of carcinoma of the distal large bowel are described in which the presenting feature was a subcutaneous abscess of the lateral aspect of the thigh. The high morbidity and mortality of this presentation are discussed and the literature is reviewed.
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