Presentation
Post colonoscopy
Patient Data
Several bowel loops in the upper pelvis are surrounded by free gas (Rigler sign). Further free gas in retroperitoneum adjacent to aorta and inferior vena cava.
Bowel gas distribution otherwise normal. No abnormally dilated bowel loops seen.
- red arrow = free retroperitoneal gas outlining the liver/IVC
- yellow arrow = free retroperitoneal gas outlining the aorta
- blue arrow = Rigler sign of free pelvic gas outlining the rectosigmoid junction
There is a large amount of free gas located with in the pelvis and retroperitoneal spaces. This appears to be arising from a perforation of the mid sigmoid colon.
At this point, the sigmoid colon lumen appears significantly narrowed. Contrast is present throughout the large bowel, extending into the rectum.
There is no obvious point of contrast extravasation from the bowel lumen. No free intraperitoneal fluid. The presence of pelvic fluid is difficult to identify due to streak artefact from the hip replacements.
Case Discussion
Patient proceeded to an ultra-low anterior resection (ULAR) and histopathology confirmed sigmoid colon as perforated with diverticulitis complicated by abscess.
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