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.