Images in clinical medicine. Diffuse subcutaneous air due to a perforated colonic diverticulum.
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BACKGROUND: Tuboovarian abscesses (TOAs) are a somewhat unusual finding in postmenopausal patients without risk factors. We present a rare case of unilateral TOA initially presenting as a brain abscess in a postmenopausal woman. CASE: A 61-year-old woman presented with a complaint of forgetfulness, nausea and vomiting, with lower abdominal pain and diarrhea. She was found to have a brain abscess, which was treated by craniotomy, with drainage of the abscess, and intravenous antibiotics. The patient was subsequently found to have a pelvic mass, which, on laparotomy, was a unilateral TOA. Pathology demonstrated that the abscess contained vegetable matter consistent with origin in a ruptured diverticulum. CONCLUSION: Diagnosis of a brain abscess should prompt a thorough investigation for a primary infectious source, including the gastrointestinal and genitourinary tracts.
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Perforation of a sigmoid diverticulum occurred in two patients in the immediate postoperative period after coronary artery surgery. Etiological factors leading to diverticular perforation after coronary artery bypass grafting are discussed. The significance of pneumoperitoneum on the postoperative chest radiograph, which prompted diagnosis in these cases, is also discussed.
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A case of cancer arising in a diverticulum of the ascending colon in a 67-year-old male is reported. The 1.5 x 1.0 cm well-differentiated adenocarcinoma protruded from the base of the inverted mucosa of the diverticulum. The surrounding flat colonic mucosa was not involved by the cancerous process. Focal stromal invasion was seen in the subserosal tissue, without association of lymph nodal involvement. This is the third reported case of adenocarcinoma arising in the colonic diverticulum.