Ulus Travma Acil Cerrahi Derg. 2011; 17(1): 93-95 | DOI: 10.5505/tjtes.2011.69783

Künt batýn travmasýna sekonder geliþen sigmoid divertikül perforasyonu nedeniyle oluþan pnömomediastinum ve subkutanöz amfizem: Olgu sunumu

Necdet Fatih Yaþar¹, Mahmut Kebapçý², Enver Ýhtiyar^1
1Eskiþehir Osmangazi Üniversitesi Týp Fakültesi, Genel Cerrahi Ana Bilim Dalý, Eskiþehir
²Eskiþehir Osmangazi Üniversitesi Týp Fakültesi, Radyoloji Ana Bilim Dalý, Eskiþehir

Pnömomediastinum ve subkutanöz amfizem divertikülit, toksik megakolon ve kolonoskopi sonrasý görülebilen kolon perforasyonunun çok nadir bir komplikasyonu olarak meydana gelebilir. Burada, geçirdiði trafik kazasýndan sonra ilk muayenesinde yokken, 3 gün sonra pnömotoraks olmaksýzýn pnömomediastinum ve subkutanöz amfizem geliþen 60 yaþýnda erkek hasta sunuldu. Çekilen bilgisayarlý tomografide sigmoid divertikül perforasyonu ile devamlýlýk gösteren serbest hava gözlendi. Laparotomide retroperitoneal kaviteye fistülize olmuþ perfore sigmoid divertikülü saptandý. Bu divertiküler perforasyonun künt karýn travmasýna sekonder geliþen sigmoid mezokolon yaralanmasýndan kaynaklandýðýný düþünmekteyiz. Tüm literatür taramamýzda mezosigmoid travmasý sonrasý sigmoid divertikül perforasyonu nedeniyle ortaya çýkmýþ pnömomediastinum ve subkutanöz amfizem olgusuna rastlayamadýk. Bu nedenle bu olgu bu konuda literatürdeki ilk olacaktýr.

Anahtar Kelimeler: Perforasyon, pnömomediastinum; sigmoid divertikülü; travma.

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Pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticulum perforation secondary to blunt abdominal trauma: report of a case

Necdet Fatih Yaþar¹, Mahmut Kebapçý², Enver Ýhtiyar^1
1Department Of General Surgery, Eskisehir Osmangazi University, Faculty Of Medicine, Eskiþehir, Turkey
²Department of Radiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskiþehir, Turkey

Pneumomediastinum and subcutaneous emphysema are very rare reported signs of colonic perforation most often associated with diverticulitis, toxic megacolon and colonoscopy. We report a case of a 60-year-old man with subcutaneous emphysema and pneumomediastinum, which developed three days after a car accident without pneumothorax. A computed tomography scan demonstrated perforation of a sigmoid diverticulum in conjunction with air. A laparotomy was performed and revealed a perforated sigmoid diverticulum, fistulized into the retroperitoneal cavity. We suspect that this diverticular perforation was caused by the deterioration of the sigmoid mesocolon secondary to the blunt abdominal trauma. To our knowledge, this is the first report in the literature about pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticular rupture following mesosigmoid trauma.

Keywords: Perforation, pneumomediastinum; sigmoid diverticulum; trauma.

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