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Surgery
Complicated retroperitoneal diverticulitis presenting with abscess and acute limb ischemia
  1. Rathnayaka Mudiyanselage Kalpanee Dhanushika Gunasingha1,
  2. Hani Seoudi2,
  3. Sohail Mirza3 and
  4. Kendal Endicott4
  1. 1General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
  3. 3Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
  4. 4Vascular Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
  1. Correspondence to Dr Rathnayaka Mudiyanselage Kalpanee Dhanushika Gunasingha; rg1430{at}outlook.com

Abstract

This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5–S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.

  • Infections
  • Gastrointestinal surgery
  • General surgery
  • Infection (gastroenterology)

https://doi.org/10.1136/bcr-2023-259467

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    Footnotes

    • X @kalguna

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: RMKDG, SM, HS and KE. The following authors gave final approval of the manuscript: RMKDG, SM, HS and KE. Is the patient one of the authors of this manuscript? No.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.