Pneumorrhachis, subcutaneous emphysema, pneumomediastinum, pneumopericardium, and pneumoretroperitoneum after proctocolectomy for ulcerative colitis: report of a case.
ABSTRACT This article presents the first known case of pneumorrhachis (spinal air), pneumomediastinum, pneumopericardium, pneumoretroperitoneum, and subcutaneous emphysema after proctocolectomy for ulcerative colitis. We review the patient's medical history, clinical and laboratory findings, radiographic data, and operative records, as well as the relevant literature. We describe the case of a young male with ulcerative colitis who developed pneumorrhachis, subcutaneous emphysema, pneumoretroperitoneum, pneumomediastinum, and pneumopericardium after a proctocolectomy with ileal pouch-anal anastomosis. Unlike the case we report, previously described episodes of pneumomediastinum and subcutaneous emphysema in patients with ulcerative colitis developed before operative intervention. We offer possible explanations for these unusual complications based on analysis of this case and thorough review of the literature.
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ABSTRACT: A 52-year-old woman who was having chemotherapy for treatment of an adenocarcinoma of the colon, was admitted to the emergency department because of a moderate neurological impairment. Head CT scan showed bifrontal pneumocephalus without fractures or discontinuities of the skull base. A few hours later, following the patient's neurologic deterioration, a new CT scan showed tension pneumocephalus with air diffusion throughout the posterior cranial fossa and cervical spine. Because of air bubbles into the cervical spine, an MRI of the entire spinal canal was done. This exam revealed a whole spine pneumorrhachis along with a transforaminal air passage through the first right sacral foramen and a pyogenic collection anterior to sacral bone. An abdomen CT scan showed a massive relapse of the colon cancer and confirmed a hypodense collection contiguous to the anterior sacral surface, causing erosion of the sacral bone and dural layer with air penetration into the spinal canal. Neurosurgical treatment by a lumbosacral laminectomy and duraplasty was followed by tumour removal and omental covering of the pelvis. Her neurological symptoms were resolved completely. One month later, the patient began adjuvant chemotherapy.Journal of Clinical Neuroscience 11/2012; · 1.25 Impact Factor
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