Retroperitoneal Air as First Sign of Sigmoid Perforation in an Octogenarian

Abstract

Sigmoid perforation is a common surgical problem at the emergency department. It usually appears with abdominal pain of sudden onset and free abdominal air in the X-ray. Nevertheless, there are a few rare cases where retroperitoneal air is the first sign of sigmoid perforation. An 82-year-old female patient visited the emergency department due to abdominal pain and blood in her stool. The patient was afebrile and no signs of rebound tenderness were revealed. The abdominal X-ray did not reveal any sign of free intraperitoneal air. An abdominal computed scan tomography was performed which revealed a large quantity of retroperitoneal air. The patient underwent diagnostic laparotomy. Her sigmoid colon had ruptured toward its mesosigmoid with no indications of diverticulitis. Sigmoidectomy was performed. Her postoperative course was uneventful and the patient was discharged 10 days after. Sigmoid perforation toward the retroperitoneal space is an extremely rare clinical scenario, which can be promptly managed only with high clinical suspicion.