Case report:
A 50-year-old man, with no significant medical history a part from obstination, arrived to the emergency department complaining of diffuses abdominal pain. Upon examination: Vital parameters were within normal limits and no signs of respiratory distress were observed, no palpable crepitus at the level of the chest and abdomen were noted. He exhibited diffuse tenderness with a maximum in left iliac fossa, without guarding. Abnormal laboratory findings included high inflammatory markers: WBC=16730/mm3, CRP=82.4 mg/L. The patient underwent a CT scan which described: Pancolic diverticulosis, regular circumferential parietal thickening of the sigmoid colon measuring 1mm in thickness and extending over 85mm, significant densification of the surrounding fat with no detectable collection (figure 1), air pockets of pneumoperitoneum opposite the antemesenteric border of the sigmoid colon, abundant retropneumoperitoneum fusing upwards to the posterior inframediastinal space figure 2). Upon these finding, we decided a conservative treatment. He was kept under strict supervision, by monitoring and serial laboratory tests. He was put under usual analgesics as well as an antibiotic therapy to prophylactic aim associating cefotaxime+metrondizole+gentamicine. A suspension of the oral food intake was instituted. Symptoms improved gradually. And inflammatory markers dropped with WBC=1030/mm3 and CRP=21 mg/L. Feeding was resumed as soon as the symptoms were relieved; a law-residue diet was started. A CT scan was requested to exclude a pericolic or distant suppurated collection and to control the volume of retropneumoperitoneum. Due to favorable evolution, he was discharged 7 days after the initial observation.