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\begin{document}

\title{Sigmoid colon perforation associated with retroperitoneal fluid
retention after vascular surgery}



\author[1]{Akira Nonogaki}%
\author[2]{Tsutomu Ihara}%
\author[3]{Shinichi Ishida}%
\author[3]{Takahiro Asada}%
\affil[1]{Nagoya University}%
\affil[2]{Tajimi Hospital}%
\affil[3]{Gifu Prefectural Tajimi Hospital}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\begin{abstract}
A patient with retroperitoneal fluid retention after vascular surgery
had a fever of unknown cause. Re-examination suggested fluid infection.
Surgery was performed, and the patient was diagnosed with colon
perforation. If the fluid volume reduces or the fluid comes into contact
with the colon, colon perforation should be suspected.%
\end{abstract}%



\sloppy


Sigmoid colon perforation associated with retroperitoneal fluid
retention after vascular surgery

Authors:

Akira Nonogaki\textsuperscript{1}, Tsutomu Ihara\textsuperscript{2},
Shinichi Ishida\textsuperscript{3}, Takahiro Asada\textsuperscript{1}

\textsuperscript{1} Department of Surgery, Gifu Prefectural Tajimi
Hospital, Tajimi, Gifu, Japan.

\textsuperscript{2} Department of Cardiac Surgery, Gifu Prefectural
Tajimi Hospital, Tajimi, Gifu, Japan.

\textsuperscript{3} Department of Vascular Surgery, Gifu Prefectural
Tajimi Hospital, Tajimi, Gifu, Japan.

Conflicts of interest: The authors declare that there are no conflicts
of interests.

Financial disclosures: The authors received no financial support for the
preparation of this article.

Acknowledgment: No relevant acknowledgments.

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

Data availability statement: The data that support the findings are
available on request from the corresponding author.

Corresponding Author: Akira Nonogaki, 5-161 Maebata-cho, Tajimi-city,
Gifu 507-8522, Japan, +81-572-22-5311, e-mail:nonononoaki@gmail.com

Key clinical message:

Infection due to fluid retention should be considered in patients with
retroperitoneal fluid retention after vascular surgery. When retained
fluids contact the colon, the fluid may reduce in volume and become
filled with air.

Abstract:

A patient with retroperitoneal fluid retention after vascular surgery
had a fever of unknown cause. Re-examination suggested fluid infection.
Surgery was performed, and the patient was diagnosed with colon
perforation. If the fluid volume reduces or the fluid comes into contact
with the colon, colon perforation should be suspected.

Key words:

Perforation of the diverticulum in the sigmoid colon, Postoperative
infection of artificial blood vessels

A 79-year-old man underwent bypass grafting. From that, retroperitoneal
fluid retention was observed around the artificial blood vessel (Figure
1). Despite being asymptomatic, the patient had a fever. Imaging
examination revealed no clear cause. Computed tomography (CT) showed the
retained retroperitoneal fluid was in contact with the sigmoid colon and
had reduced. There was no improvement with antibiotics, the patient was
re-examined. CT showed further reduction of the fluid and internal air
(Figure 2). The patient was diagnosed with an infection of retained
retroperitoneal fluids involving the sigmoid colon, and surgery was
performed.

The retained fluids were mixed with pus. In addition to drainage and
sigmoid colectomy, artificial blood vessel removal and new bypass
grafting were performed. Histopathologically, the diagnosis was
inflammation associated with the perforation of a diverticulum in the
sigmoid colon.

Because the diverticulum of the colon perforated to retroperitoneal
fluid retention around the artificial blood vessel, the cause of
infection was not detected by imaging, which made the diagnosis
difficult. In such patients\textsuperscript{1}, if the retained
retroperitoneal fluid is in contact with the intestinal tract or if the
retained fluids reduced in the case of an unexplained infection, fluid
infection due to gastrointestinal perforation should be considered.

Reference:

1. Leroy O, Meybeck A, Sarraz-Bournet B, d'Elia P, Legout L. Vascular
graft infections. \emph{Curr Opin Infect Dis} . Apr 2012;25(2):154-8.
doi:10.1097/QCO.0b013e3283501853

Figure captions:

Figure.1 CT showed retroperitoneal fluid retention (yellow arrowhead)
around the artificial blood vessel (red arrow). CT, computed tomography.

Figure.2 CT showed the air inside the fluid retained in the
retroperitoneum (yellow arrowhead). CT, computed tomography.

Ethical statement:

Institutional review board approval was exempted at our institution for
this retrospectively designed report and informed consent was obtained
from the patient to publish this report.

Author contributions:

AN: wrote the draft of the manuscript and prepared the figures. AN and
TI: involved in writing. AN, TI, SI and TA: revised and approved the
final manuscript.\selectlanguage{english}
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