Images in clinical medicine
A 55-year old Albanian female, under treatment for intestinal diverticulosis, noted an increase in painful sensations in the lower abdomen, as well as an unexpected sense of suffocation. She had a previous colonoscopy two years before re-appearing for consultancy, and the examination was repeated under anesthesia (midazolam, fentanyl).
20 centimeters from the anal margin a bleeding diverticulum approaching two centimeters in diameter was noted; some thirty centimeters orad other diverticula with normal mucosal appearance are seen (Figure 1A and 1B).
The patient had the same afternoon a total body CT scan and an abdominal CT scan with oral contrast enhancement. Air bubbles were visible in both perirenal areas, advancing to the mediastinum and subcutaneously laterally, mostly in the left subaxillary and supraclavicular spaces, and reaching the neck structures (Figure 2A-C).