case_images: PMC6376157_01
case_images: Chest radiography showing subcutaneous emphysema of the neck, mediastinal emphysema, and subdiaphragmatic free air (red arrows).
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case_images: A recurrence of pneumothorax was suspected, and chest radiography was performed, which revealed subcutaneous emphysema of the neck, mediastinal emphysema, and subdiaphragmatic free air (Fig. 1).
case_images: Selected images from a computed tomography (CT) scan of the chest, abdomen, and pelvis (a, b, and c: axial images; d: reformatted coronal images). CT demonstrated perforation of the sigmoid colon into the mesentery (c, red arrows). Using lung windowing, gas was found extensively, from the retroperitoneum to the mediastinum (a, b, and d, red arrows).
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case_images: This showed extensive retroperitoneal and mediastinal emphysema, including emphysema of the sigmoid colon mesentery (Fig. 2a-d).
case_images: Intraoperative image showing intestinal emphysema (a) and necrotizing and perforating mesentery of the sigmoid colon (b: laparoscopy, c: open laparotomy).
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case_images: Diagnostic laparoscopy was performed under general anesthesia, and it revealed that the perforation was in the sigmoid mesentery (Fig. 3a-c).
case_images: In the macroscopic examination of the surgical specimen, the diverticulum communicates with the outside of the mesentery without signs of malignancy (the inserted probe penetrated the lumen).
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case_images: Macroscopy of the surgical specimen revealed that the diverticulum was communicating with the outside of the mesentery without signs of malignancy, thus, it was diagnosed as a diverticular penetration (Fig. 4).