Supralevator Abscess Presenting With Pneumoarthrosis And Retroperitoneal Air, A Case Report

74-year-old male presented to the emergency department with complaint of fever, weakness, and fatigue and was admitted to the hospital for further workup. The patient was found to have gram negative bacteremia and Clostridioides difficile infection. Computed tomography imaging of the abdomen and pelvis was obtained and demonstrated air in the retroperitoneal/ presacral space tracking to the left hemipelvis and femoral joint. Concern for possible septic joint lead to an Orthopedic surgery evaluation and magnetic resonance imaging of the left hip and pelvis which revealed a complicated perirectal infection tracking to the left hemipelvis. The patient was taken to the operating room with colorectal surgery for further management and treatment.

A rare complication of the duodenal diverticulum

IntroductionAn 80-year-old woman presented to the emergency department with severe right-sided abdominal pain that had started after her last meal. Physical examination revealed fever (38.6°C) and rebound tenderness in the right upper quadrant of the abdomen. The laboratory studies showed a leucocyte count of 11.3×109/L (normal, 3.7–8.0×109/L) and a C-reactive protein level of 2.34 mg/dL (normal, <0.03 mg/dL). There were no other significant findings. A CT scan of the abdomen with contrast revealed retroperitoneal air around a duodenal diverticulum (figures 1 and 2).Figure 1Computed tomography scan of the abdomen with contrast (coronal section). A diverticulum in the second portion of the duodenum (arrow) and retroperitoneal air (asterisk) are shown.Figure 2Computed tomography scan of the abdomen with contrast (axial section). The area with retroperitoneal air (asterisk) is marked.QuestionWhat is the most likely diagnosis and the cause underlying the condition?

Perforation of a Retrocecal Appendix Resulting in Retroperitoneal Air: A Case Report

There have been several case reports documenting acute appendicitis complicated by perforation presenting with retroperitoneal abscess formation. To date, there are no case reports of acute appendicitis in which the only sign for retroperitoneal perforation is the presence of retroperitoneal air as detected by computed tomography (CT). In the case presented, an 18-year-old male presented to the emergency department with clinical symptoms of acute appendicitis. CT exam demonstrated an inflamed appendix with multiple collections of air in the retroperitoneum, without abscess. Laparotomy revealed perforation of a retrocecal appendix into the retroperitoneum.