Sample records for retropneumoperitoneum

  1. Pancreatitis caused by Clostridium perfringens infection with extensive retropneumoperitoneum

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    Merchante, E.; Garcia, F. J.; Perez, H.; Marquez, J. L.


    We present a case of primary emphysematous pancreatitis caused by Clostridium perfringens infection (also Known as spontaneous pancreatic gas gangrene) in a 66-year-old man with diabetes and a history of recurrent pancreatitis. One notable feature is the absence of a focal distribution, which is seen on radiological studies to be accompanied by extensive retropneumoperitoneum, with dissemination of the gas toward the mesenteric root and pelvic extra peritoneal spaces. This wide diffusion is aided by the C. perfringens toxins and the pancreatic enzymes released, leading to a fulminate course, an elevated rate of early mortality among the cases reviewed. The early diagnosis of this disease is fundamental, enabling aggressive medical treatment and emergency surgery. Diabetes is a known risk factor for anaerobic infection, including C. perfringens, as in the case of emphysematous cholecystitis. A diseased pancreas or pancreatic duct facilitates the development of infections since it eliminates poorly the microorganisms that reach it from the duodenum. Gas gangrene secondary to necrosis-related super infection or pancreatic collections is uncommon, and spontaneous or primary cases are exceptionally are. (Author) 13 refs

  2. [Pneumomediastinum, giant subcutaneous emphysema and pneumoperitoneum revealed by jaw pain. Uncommon physiopathology of pneumomediastinum]. (United States)

    Le Loch, J-B; Freymond, N; Khettab, F; Pacheco, Y; Devouassoux, G


    Spontaneous pneumomediastinum is a rare entity, predominantly described in young man. The association of acute dyspnea, chest pains and subcutaneous emphysema is usually reported. We report the observation of a pneumomediastinum, fortuitously discovered in front of an isolated giant subcutaneous emphysema in a 59 year old man. The recent clinical history was only marked by the presence of intense and acute dental pains. Associated with a pneumoperitoneum, a retro-pneumoperitoneum, this clinical presentation is uncommon and differs from previous published case reports. Despite a complete evaluation of classical risk factors, its origin remains uncertain. However, the presence of huge dental injuries led to consider such local origin, facilitating air diffusion. This case report allows to reconsider spontaneous pneumomediastinum entity and to propose additional physiopathological mechanisms. This original description underlines the interest to systematically perform dental examination in the presence of unexplained pneumomediastinum.

  3. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

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    S. Fosi


    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  4. Laparoscopic correction of enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome. (United States)

    Carriero, Alfonso; Picchio, Marcello; Martellucci, Jacopo; Talento, Pasquale; Palimento, Domenico; Spaziani, Erasmo


    We report our experience of concomitant laparoscopic treatment for enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS). From June 2005 to June 2007, we submitted 20 patients with ODS due to rectal prolapse and/or rectocele, combined with stable enterocele, to STARR and laparoscopic correction of the enterocele. Preoperative assessment included symptom evaluation with standardized questionnaires, clinical examination, colonoscopy, proctoscopy, anal sphincter ultrasonography, video-defecography with synchronous opacification of the ileal loops in all patients and colpography in female patients, and anorectal manometry. Follow-up was performed in the first, third, sixth, 12th, and 24th month after surgery. Eighteen (90%) patients were submitted to both procedures, simultaneously. One patient, previously submitted to STARR, underwent laparoscopic treatment of the enterocele. Postoperative complications occurred in two (10%) patients: one case of postoperative rectal bleeding and one case of retropneumoperitoneum. Median (range) preoperative and postoperative Altomare's obstructed defecation score was ten (6-14) and two (0-14), respectively (p<0.001). Median (range) preoperative and postoperative quality of life score was 79 (39-109) and 109 (50-126), respectively (p<0.001). No symptom related to ODS was detected at 6-month follow-up (19 patients) and at 24-month follow-up (19 patients). The combination of STARR and laparoscopy provides a safe and effective method to treat ODS caused by rectal internal prolapse and/or rectocele combined with enterocele.

  5. Posterior Retroperitoneoscopic Resection of Extra-adrenal Paraganglioma Located in the Aorto-caval Space. (United States)

    Kang, Sang-Wook; Kandil, Emad; Kim, Min Jhi; Kim, Kwang Soon; Lee, Cho Rok; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo


    The posterior retroperitoneoscopic adrenalec tomy has several advantages compared with the transperitoneal approach such as a shorter and more direct route to the target organ, no breach of the intraperitoneal space, and no required retraction of the adjacent organs. It also is a safe procedure with a short learning curve.1 - 5 This report presents a challenging case of an extra-adrenal paraganglioma located in the aorto-caval space and managed using the retroperitoneal approach. A 39-year-old man was placed in the prone jackknife position, and three incisions were made in the right posterior abdominal wall for placement of the laparoscopic ports. The retroperitoneal space was entered with diathermy and blunt finger dissection, and retropneumoperitoneum was achieved with carbon dioxide insufflation pressure up to 18 mmHg. After identification of the right kidney and vessels, the tumor was meticulously dissected and excised with an energy device. The specimen was removed using a laparoscopic specimen retrieval bag, and the port sites were closed in layers. The operative time was 130 min, and the total blood loss was 30 ml. The tumor was diagnosed as a moderately differentiated extra-adrenal paraganglioma. The Von Hippel-Lindau gene mutation was detected using next-generation sequencing. The posterior retroperitoneoscopic approach is a safe, feasible, and effective method for excising an extra-adrenal paraganglioma even in the aorto-caval space. The authors suggest that this procedure is a useful surgical option for treatment of an aorto-caval paraganglioma for selected patients and by experienced surgeons.

  6. Renal Scintiscanning with Hg{sup 209}-Neohydrin in Urologic Diseases; Scintigraphy du Rein dans les Maladies des Voies Urin Aires au Moyen de Neohydrine Marquee avec {sup 203}Hg; Stsintillyatsionnoe skennirovanie pochek s pomoshch'yu neogidrina,mechennogo Rtut'yu-203, pri urologicheskikh zabolevaniyakh; Exploracion Centelleografica del Rinon con Neohydrina - {sup 203}hg en las Afecciones Urologicas

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    Bollini, V.; Tori, G. [Radiology Institute of the University of Bologna (Italy)


    which point to a compensatory hypertrophy should be distinguished from the dishomogeneous and irregular ones. These last pictures suggest the presence of large hydronephroses, tumours or multiple cysts. In renal vascular disease, the character of the uptake in the two kidneys can be of significant value in assessing the reduced function and in differentiating unilateral from bilateral diseases. Renal scintiscanning thus shows promise of proving a useful clinical technique, particularly if combined with radiological examination of the kidneys by traditional means (urography, ascending pyelography, retropneumoperitoneum, tomography, aortography, etc.). (author) [French] Les auteurs ont procede a des scintigraphies du rein au moyen de neohydrine marquee avec {sup 203}Hg. Ils ont utilise le dispositif de scintigraphie 'NuclearChicago', type 1700, a cristal de 5 x 5 cm et collimateur alveolaire de 7 cm de distance focale. En general, les scintigrammes sont enregistres a la fois sur papier et sur film photographique; la neohydrine marquee avec {sup 203}Hg est administree en doses de 120 a 160 {mu}c (environ 2 {mu}c/kg). L'examen scintigraphique commence deux heures environ apres l'injection et dure de 40 a 50 min. Le fait que la neohydrine marquee se fixe selectivement au niveau du cortex renal permet d'obtenir une representation graphique des deux reins et de determiner leur position, leur orientation et leur forme, ainsi que le degre d'homogeneite du parenchyme normal. Dans certains cas, des examens autobiographiques ont ete effectues sur des reins malades, apres ablation. Cette methode permet de determiner les anomalies, congenitales ou acquises, dans la position et l'orientation des reins. En ce qui concerne la forme de l'organe, les contours de l'image du rein sont d'autant plus nets que la fonction renale est meilleure. Des caracteristiques techniques telles que la largeur du cristal, le collimateur (dont le plan focal doit couper le plan median transversal des