case_images: PMC9950965_01
case_images: Computed tomography on postoperative day 3 shows mediastinal emphysema (a), retroperitoneal emphysema around the pancreas (b), retroperitoneal emphysema at the dorsal descending colon (c), but no fluid or air collections around the anastomosis (d). Arrows: areas of subcutaneous, retroperitoneal, and mediastinal emphysema. Arrowhead: area of the anastomosis.
case_images: crg-2022-0017-0001-529282_f1.jpg
case_images: PMC9950965_01_crg-2022-0017-0001-529282_f1.jpg
case_images: F1
case_images: Fig. 1). CT confirmed these findings (Fig. 1), showing a massive amount of air in the retroperitoneum around the pancreas; a small amount of air was also present at the dorsal descending colon. Retrospective review of the CT from POD 3 revealed small fluid and air collections at that location (Fig. 1c); these had grown significantly larger by POD 23 (Fig. 2c), suggesting perforation of the descending colon.
case_images: Computed tomography on postoperative day 23 shows resolution of the mediastinal emphysema (a), resolution of the retroperitoneal emphysema around the pancreas (b), and development of localized fluid and air collections in the retroperitoneum, contiguous with the descending colon (c). Arrow: area of the fluid and air collections in the retroperitoneum. Arrowhead: area of the continuity with the descending colon and fluid and air collections in the retroperitoneum.
case_images: crg-2022-0017-0001-529282_f2.jpg
case_images: PMC9950965_01_crg-2022-0017-0001-529282_f2.jpg
case_images: F2
case_images: On POD 23, the patient was asymptomatic, but the CRP level elevated to 6.48 mg/dL (WBC: 5,800/microL); thus, we performed CT (Fig. 2).
case_images: Preoperative computed tomography shows a diverticulum of the descending colon, corresponding to the site of postoperative perforation. Arrow: diverticulum.
case_images: crg-2022-0017-0001-529282_f3.jpg
case_images: PMC9950965_01_crg-2022-0017-0001-529282_f3.jpg
case_images: F3
case_images: The perforation site was at the same location as a diverticulum noted on the patient's preoperative CT (Fig. 3).