Rectal perforation, a rare presentation of a swollen limb
Keywords:Soft tissue infection, Perforation of rectum, Diversion colostomy
Soft tissue infection of right lower limb secondary to perforation of the gastrointestinal tract is very rare and the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the clinician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities. The mechanisms and anatomical pathways are discussed in this case report. Diversion colostomy with incision and drainage of the lower limb of the same is a safe and feasible option.
Gerrit JJ, Henk RV, Joseph JH. Subcutaneous emphysema of the lower extremity of abdominal origin. Gastrointestinal Radiology. 1990;15(1).
Henry KO, Kramer NE, Branch WE. Subcutaneous emphysema of gastrointestinal origin. The American Journal of Medicine. 1955;19(6).
Keun-Bae L, Eun-Sun M, Sung-Taek J, Hyoung-Yeon S. Subcutaneous Emphysema Mimicking Gas Gangrene Following Perforation of the Rectum: A Case Report. Journal of Korean Medical Science. 2004;19(5).
Sjolin SU, Andersen JC. Adenocarcinoma of the colon presenting as lower extremity gas gangrene (Metastatic myonecrosis). Acta Chir Scand. 1986;152:715-6.
Nordkild P, Crone P. Spontaneous clostridial myonecrosis: a collective review and report of a case. Ann Chir Gynaecol. 1986;75:274-9.
Saldua Nelson S., Fellars Todd A., Covey Dana C. Case Report: Bowel Perforation Presenting as Subcutaneous Emphysema of the Thigh. Clinical Orthopaedics and Related Research®. 2009;468(2).
McMullin NR, Gering S, Levoyer T. Necrotizing Fournier’s gangrene from a perforated rectal carcinoma. Surg Rounds. 2006;29:275.
Hafez Mahmoud A. Subcutaneous emphysema of the leg: Could be a fatal condition. Open Journal of Clinical Diagnostics. 2012;02(03).