Case contributed by Dr Bruno Di Muzio


Progressive pelvic pain for two days. History of colonoscopy performed three days ago.

Patient Data

Age: 73
Gender: Female

CT Abdomen and pelvis (selected images)

Protocol for acute abdomen performed without contrast injection.

Inflammation of the proximal portion of the rectum characterized by blurring of fat around.  Many gas bubbles inferring loop drilling, the extension to above retroperitoneum confirms the origin of the perforation on a retroperitoneal loop, rectum.

Annotated image

Gas bubbles dissecting 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 presence of gas within the retroperitoneal space. It is always abnormal. 

The perforation may have occurred by colonoscopy procedure. The most site of colonic perforation is the rectosigmoid colon. 

The differential diagnosis being thought would be a complicated acute diverticulitis with perforation loop.

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Case information

rID: 20710
Case created: 8th Dec 2012
Last edited: 27th Aug 2016
Inclusion in quiz mode: Included

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