WTP7.13 Simultaneous pneumoperitoneum and pneumomediastinum- would you guess sigmoid diverticular perforation? A Case Report

Abstract Introduction Simultaneous pneumoperitoneum and pneumomediastinum is a rare radiological finding. There are only 6 reported cases in the literature of this being due to diverticular perforation. Case report A 78-year-old male presented with worsening shortness breath, lower back pain abdominal pain. Past medical history included myasthenia gravis, for which he took pyridostigmine. computed tomography (CT) abdomen pelvis contrast identified pneumoperitoneum, subcutaneous emphysema neck. The site perforation was unclear radiologically. Urgent diagnostic laparoscopy revealed sigmoid colon secondary diverticulitis. procedure subsequently converted an open Hartmann’s Procedure. Extensive within mesentery noted intra-operatively. Post-operative recovery complicated by chest infection but patient recovered well discharged home on day 15. Discussion Colonic disease increasing prevalence worldwide. most common diverticulitis (an intraperitoneal structure). Perforation serious complication that can require urgent surgery. Pneumoperitoneum well-recognised sign perforation, however far rarer. Posterior perforations have potential enter posterior para-renal space, penetrate diaphragmatic hiatus present pneumomediastinum. Conclusion rarely caused colonic This lead delayed diagnosis poorer prognosis.