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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five cases of perforated diverticular disease are described in which pain in the thigh or leg was the predominant symptom. In four patients pyrexia or leucocytosis were present and three patients ultimately developed surgical emphysema in the left thigh. In retroperitoneal perforation of the colon, the symptoms in the leg may overshadow those in the abdomen and lead to delay in diagnosis.
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PMID:Leg pain: an uncommon presentation of perforated diverticular disease. 270 51

Infections are an increasing problem in the elderly population, because of the often atypical presentation and the more frequent occurrence of complications, which lead to increased morbidity and mortality. The increased prevalence of infections in the elderly is due to a number of factors: increased exposure to micro-organisms (especially in nursing homes); degeneration of various organs (atherosclerosis, pulmonary emphysema, diverticulosis, prolapse); decreased immune response; concomitant diseases (e.g. diabetes mellitus) and (or) use of medication. There is often a delay in the diagnosis because the presentation of infection in the elderly is frequently atypical and symptoms are attributed to old age, rather than to infection. Treatment may be hampered by increased resistance of micro-organisms, interaction with other drugs and toxicity problems.
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PMID:[Infections in elderly patients]. 955 Jul 96

This case report describes an acute colonic diverticular perforation occurred to a multiple myeloma patient, taking corticosteroid and morphine therapy, revealed by a subcutaneous emphysema of upper chest and right abdomen as initial presentation. Sigmoid diverticulitis with perforation and generalized peritonitis is a severe complication of the diverticular disease and it is due to diverticular microperforation. This condition occurs more frequently in patients with widespread diverticolosis and usually after 50 years of age, and the frequency of related complications increases with age (and with the use of corticosteroids). Extraperitoneal air from the sigmoid-rectum perforation can escape diffusing superiorly though paravertebral retroperitoneal tissues and via the diaphragmatic iatus into the mediastinum, producing pneumomediastinum and it diffuses to yield superior thoracic emphysema. This report suggests that the diagnosis of retroperitoneal perforation is usually difficult because of the lack of signs of peritoneal irritation and the paucity of symptoms, particularly in patients treated with corticosteroids.
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PMID:Acute colon diverticulitis in multiple myeloma patient: an unusual presentation of a colonic perforation. Case report. 1282 May 90

During the past 5000 years, ancient nomenclature and dogmas regarding the etiology of protrusions have accumulated. Whereas, in the abdomen, the Latin "hernia" supplanted Greek, it, based on content, persists in the pelvis as cystocele, rectocele, etc. Russell (Lancet 1:1519-1523, 1902) championed the congenital saccular theory of herniae, denying they could ever be acquired pathologically. Barring technical error, removal of the sac would cure. Despite dissent in the 1920s by Harrison, Keith, and Andrews, Russell's concepts held late into the twentieth century. We now know that pathology - systemic connective tissue disease - plays an important role in adult herniation. Tensionless prosthetic repair is usually required since the healing of damaged musculo-aponeurotic structures in abdomen or pelvis is impaired. Laparoscopists have declared sliding extraperitoneal prolapse of sacless kidney, ureter, bladder, and fat pad to be herniae. Similar vaginal protrusions should be denoted likewise. It is time gynecologists and herniologists join in the effort to develop antidotes for combating this pernicious co-morbidity which has been shown also to cause aneurysms, diverticulosis coli, skin changes, and emphysema. Prophylaxis should include exercise and going without cigarettes.
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PMID:Archaic terms and dogmas impeding care of abdominal and pelvic herniation. 1750 28

With advancing age and the affluent, low-fiber Western diet, the incidence of diverticular disease is increasing. Fortunately, most cases can be managed conservatively without resorting to surgical intervention. Life-threatening complications such as perforation, especially when it is associated with gross fecal contamination, requires urgent aggressive surgical intervention. A 75-year-old man with absolute constipation and pain in the left iliac fossa underwent urgent laparotomy following fluid and antibiotic resuscitation. A posterior perforated sigmoid diverticulitis associated with myofascial necrosis and generalized pelvic emphysema was identified. In cases where perforation occurs posteriorly and the only external manifestation is surgical emphysema, the outcome is generally favorable.
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PMID:Subcutaneous emphysema, muscular necrosis, and necrotizing fasciitis: an unusual presentation of perforated sigmoid diverticulitis. 2022 8

The Nyhus-Wantz Lectureship honors two giants who represent the few who formed a new surgical specialty: herniology. My topics are etiology, herniosis, diverticulosis coli, and cancer. Hippocrates blamed wear and tear for herniation. Russell's (Lancet 1:1519-1523, 1902) explanation was congenital peritoneal "buds" extending down to the pelvis. Harrison (Arch Surg 4:680-689, 1922) attributed herniae to transversalis fascial degradation. Keith (Lancet 2(17):1398-1399, 1906) concluded that pathology was involved, even though Russell (Lancet 1:1519-1523, 1902) had denied it. Nevertheless, the congenital theory prevailed. According to McVay (Christopher's textbook of surgery, W.B. Saunders, Philadelphia, 1960, p. 159), defects arise in normal musculo-aponeurotic structures. Research showed that atrophy was caused by damaged fibroblasts producing less collagen, which was abnormal (having a reduced I/III ratio). The disease was systemic, later named herniosis. Nicotine addiction increased the incidence of herniation by an inflammatory process named metastatic emphysema. In 1948, Saint's Triad, an aggregation of hiatus hernia (later, any primary hernia), gallstones, and diverticulosis coli, was introduced. This association occurred eight times more often than expected, with herniosis appearing to be its cause, abetted by high blood cholesterol causing gallstones. In 2006, Krones et al. (Int J Colorectal Dis 21:18-24, 2006) provided evidence that colon cancer is accompanied by a reduction in diverticula. Klinge et al. (Hernia 8(4):300-301, 2004) showed that these entities require different extracellular matrices (ECMs). Ghajar and Bissell (Histochem Cell Biol 130:1105-1118, 2008) pointed out that the ECM, which comprises 80% of the breast, influences its epithelial genetic expression, likewise with other organs (kidney, skin, lung, colon, and ovaries). Recently, a fundamental change in our understanding of cancer growth and metastasis has taken place. Whereas the degradation of connective tissue was thought to encourage invasion, eliciting concern for the herniated, now, investigators report the reverse, a reactive vascularized stroma resembling wound healing with an increase in fibroblasts and collagen I. Words such as desmoplasia, fibrosis, and stiffening abound. In conclusion, degradation of the ECM may be why herniosis appears to be hostile to the development of cancer throughout the body. Studies are needed of patients with and without a history of hernia to determine their incidence of cancer. Data from smokers should be separated, since they carry their own high risk of malignancy.
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PMID:The Nyhus-Wantz lectureship: etiology, herniosis, diverticulosis coli, and cancer. 2159 Apr 41

Cutis laxa (CL) is a rare congenital and acquired disorder characterized by loose and redundant skin with reduced elasticity. Three types of congenital cutis laxa have been recognized. Other findings are pulmonary emphysema, bronchiectasia, hernia and diverticulosis. We describe a female neonate involved by cutis laxa syndrome and a positive family history. We focus on the radiologic findings of this case such as multiple bladder diverticulosis, GI diverticulosis and very rare accompanying hypertrophic pyloric stenosis (HPS).
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PMID:Radiologic findings in cutis laxa syndrome and unusual association with hypertrophic pyloric stenosis. 2404 87

The onset of colon diverticular disease is a frequent event, with a prevalence that increases with age. Amongst possible complications, free peritoneal perforation with abscess formation may occur. We herein describe two rare presentations of an extraperitoneal sigmoid diverticulum perforation. Our first patient, an 89-year-old female with no signs of distress, developed a subcutaneous abscess and emphysema in an incisional hernia following an appendectomy through a McBurney incision. The second patient, an 82-year-old female, was in general distress at the time of her admission and had a more advanced infection following the occurrence of a sigmoid perforation in a hernial sac. Complicated diverticulitis has a known course and evolution, but with an extraperitoneal presentation, this etiology is not expected. A computed tomography (CT) scan should be completed if the patient is hemodynamically stable, and wide debridement should be performed. Subcutaneous emphysema with an acute abdomen may be a sign of sigmoid perforation. Clinicians should keep this etiology in mind, regardless of the initial presentation.
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PMID:Subcutaneous Emphysema Caused by an Extraperitoneal Diverticulum Perforation: Description of Two Rare Cases and Review of the Literature. 3015 36

Diverticular disease is a common clinical condition among Western populations, which increases with age. It can present in a variety of manners and has myriad of potential disease complications. We present a rare case of an adult patient with an extraperitoneal complications of a diverticular perforation presenting with facial swelling due to a colo-urachal fistula associated with a patent urachal remnant. Perforation should be considered in patients presenting with surgical emphysema with background of diverticular disease.
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PMID:A rare case of a diverticular perforation associated with colo-urachal fistula presenting as anaphylaxis. 3169 62