Case Report
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Nadir Bir Bacak Ağrısı Nedeni: Divertikül Perforasyonu, Apse Formasyonu

Year 2021, Volume: 4 Issue: 4, 143 - 145, 29.12.2021
https://doi.org/10.54996/anatolianjem.997024

Abstract

Amaç: Divertiküler hastalıklar çoğunlukla asemptomatik seyretmekte ve özellikle batı ülkelerinde çoğunlukla kırk yaş üzeri hastalarda görülmektedir. Karın ağrısı en sık semptom olmakla birlikte tekrarlayan divertikülit ataklarına sahip hastalar atipik prezentasyonlarla başvurabilmektedir.

Olgu: 89 yaşında erkek hasta acil servise iki gündür devam eden ve giderek artan sol bacak ağrısı ile acil servise başvurdu. Hastada divertikülit ve divertiküle sekonder sigmoid kolonun perfore olarak psoas kası üzerinden superior ve inferiora doğru uzanan retroperitonel bir poş içinde apse oluşumuna neden olduğu tespit edildi.

Sonuç: Tekrarlayan divertikülit ataklarının skar ve adezyon oluşumuna neden olduğu ve bu yüzden lokalize perforasyonların ve apselerin jeneralize peritonitler yerine görülebilir. Komşu psoas kasında apse formasyonu ile komplike olan ve alt ekstremite ağrısı ile gelen atipik bir divertikülit vakaları, hastalar için yüksek morbidite ve mortalite ile sonuçlanabilmektedir.

Supporting Institution

Bulunmamaktadır.

Project Number

Bulunmamaktadır.

References

  • Spiller RC. Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterol Motil. 2015 Mar;27(3):305-12. doi: 10.1111/nmo.12526.
  • Moubax K, Urbain D. Diverticulitis: new insights on the traditional point of view. Acta Gastroenterol Belg. Jan-Mar 2015;78(1):38-48.
  • Rafailidis V, Gavriilidou A, Liouliakis C, et al. Abdominal wall abscess due to acute perforated sigmoid diverticulitis: a case report with MDCT and US findings. Case Rep Radiol. 2013;2013:565928. doi: 10.1155/2013/565928.
  • Etzioni DA, Mack TM, Beart Jr RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009 Feb;249(2):210-7.
  • Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol. 2011 Mar 28;17(12):1600-5.
  • Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975 Jan;4(1):53-69.
  • Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984 Oct;200(4):466-78.
  • Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003 Dec;186(6):696-701.
  • Murphy PB, Belliveau P. Left-sided sigmoid diverticulitis presenting as right-sided thigh abscess. Int Surg. Oct-Dec 2012;97(4):285-7. doi: 10.9738/CC144.1.
  • Amor IB, Kassir R, Bachir E, et al. Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula. Int J Surg Case Rep. 2015;8C:73-5. doi: 10.1016/j.ijscr.2014.12.034.
  • Frueh FS, Vuille-Dit-Bille RN, Raptis DA, et al. Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft—a case report. BMC Surg. 2014 Jul 22;14:46. doi: 10.1186/1471-2482-14-46.
  • Naraynsingh V, Maharaj R, Hassranah D, et al. Perforated left-sided diverticulitis with faecal peritonitis: is theHinchey classification the best guide for surgical decision making? Tech Coloproctol. 2011 Jun;15(2):199-203. doi: 10.1007/s10151-011-0675-7.
  • Lee YT, Lee CM, Su SC, et al. Psoas abscess: a 10 year review. J Microbiol Immunol Infect. 1999 Mar;32(1):40-6.
  • Ogihara M, Masaki T, Watanabe T, et al. Psoas abscess complicating Crohn's disease: report of a case. Surg Today. 2000;30(8):759-63.
  • Laméris W, van Randen A, Bipat S, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008 Nov;18(11):2498-511.

A Rare Cause of Leg Pain: Diverticule Perforation, Abscess Formation

Year 2021, Volume: 4 Issue: 4, 143 - 145, 29.12.2021
https://doi.org/10.54996/anatolianjem.997024

Abstract

Aim: Diverticular diseases are mostly asymptomatic and are mostly seen in patients over the age of forty, especially in western countries. Although abdominal pain is the most common symptom, patients with recurrent diverticulitis attacks may present with atypical presentations.

Case: An 89-year-old male patient presented to the emergency department with left leg pain that had been going on for two days and was increasing. It was detected that diverticulitis and the sigmoid colon secondary to diverticulitis caused abscess formation in a retroperitoneal pouch extending superiorly and inferiorly over the psoas muscle.

Conclusion: Recurrent episodes of diverticulitis cause scarring and adhesion formation and therefore localized perforations and abscesses can be seen instead of generalized peritonitis. Cases of atypical diverticulitis with lower extremity pain complicated by abscess formation in the adjacent psoas muscle can result in high morbidity and mortality for patients.

Project Number

Bulunmamaktadır.

References

  • Spiller RC. Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterol Motil. 2015 Mar;27(3):305-12. doi: 10.1111/nmo.12526.
  • Moubax K, Urbain D. Diverticulitis: new insights on the traditional point of view. Acta Gastroenterol Belg. Jan-Mar 2015;78(1):38-48.
  • Rafailidis V, Gavriilidou A, Liouliakis C, et al. Abdominal wall abscess due to acute perforated sigmoid diverticulitis: a case report with MDCT and US findings. Case Rep Radiol. 2013;2013:565928. doi: 10.1155/2013/565928.
  • Etzioni DA, Mack TM, Beart Jr RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009 Feb;249(2):210-7.
  • Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol. 2011 Mar 28;17(12):1600-5.
  • Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975 Jan;4(1):53-69.
  • Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984 Oct;200(4):466-78.
  • Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003 Dec;186(6):696-701.
  • Murphy PB, Belliveau P. Left-sided sigmoid diverticulitis presenting as right-sided thigh abscess. Int Surg. Oct-Dec 2012;97(4):285-7. doi: 10.9738/CC144.1.
  • Amor IB, Kassir R, Bachir E, et al. Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula. Int J Surg Case Rep. 2015;8C:73-5. doi: 10.1016/j.ijscr.2014.12.034.
  • Frueh FS, Vuille-Dit-Bille RN, Raptis DA, et al. Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft—a case report. BMC Surg. 2014 Jul 22;14:46. doi: 10.1186/1471-2482-14-46.
  • Naraynsingh V, Maharaj R, Hassranah D, et al. Perforated left-sided diverticulitis with faecal peritonitis: is theHinchey classification the best guide for surgical decision making? Tech Coloproctol. 2011 Jun;15(2):199-203. doi: 10.1007/s10151-011-0675-7.
  • Lee YT, Lee CM, Su SC, et al. Psoas abscess: a 10 year review. J Microbiol Immunol Infect. 1999 Mar;32(1):40-6.
  • Ogihara M, Masaki T, Watanabe T, et al. Psoas abscess complicating Crohn's disease: report of a case. Surg Today. 2000;30(8):759-63.
  • Laméris W, van Randen A, Bipat S, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008 Nov;18(11):2498-511.
There are 15 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Case Report
Authors

Barış Murat Ayvacı 0000-0003-4760-025X

Murat Çetin 0000-0002-0667-7966

Hüseyin Sami Şahin This is me 0000-0003-2443-6469

Project Number Bulunmamaktadır.
Publication Date December 29, 2021
Published in Issue Year 2021 Volume: 4 Issue: 4

Cite

AMA Ayvacı BM, Çetin M, Şahin HS. Nadir Bir Bacak Ağrısı Nedeni: Divertikül Perforasyonu, Apse Formasyonu. Anatolian J Emerg Med. December 2021;4(4):143-145. doi:10.54996/anatolianjem.997024