Presentation
Progressive pelvic pain for two days. Medical history of colonoscopy performed three days ago.
Patient Data
Inflammation of the rectum characterized by surrounding fat stranding.
The multiple gas bubbles extending along the retroperitoneum confirms the origin of the perforation to be a retroperitoneal bowel segment, in this case, the rectum.
Small amount of pneumoperitoneum.
Gas bubbles dissecting along the retroperitoneum. Arrows indicate some of the retroperitoneal structures, such as the esophagus, kidney, aorta, psoas muscle, and rectum.
Case Discussion
Pneumoretroperitoneum is by definition the presence of gas within the retroperitoneal space. It is always abnormal.
The perforation may have occurred during the colonoscopy procedure. The most common site of colonic perforation is the rectosigmoid colon.
A differential diagnosis to consider is complicated acute diverticulitis with perforation.
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