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\begin{document}

\title{Pneumoretroperitoneum, pneumomediastinum and neck emphysema due to
rectal diverticulosis}



\author[1]{Floreta Kurti}%
\author[2]{Viola Cala}%
\author[3]{Gentian Vyshka}%
\affil[1]{University Hospital Center “Mother Theresa” Tirana, Albania}%
\affil[2]{University Hospital Center “Mother Theresa”, Tirana, Albania}%
\affil[3]{Faculty of Medicine, University of Medicine }%


\vspace{-1em}



  
  \date{May 08, 2024}


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\selectlanguage{english}
\begin{abstract}
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. 20 centimeters
from the anal margin a bleeding diverticulum approaching two centimeters
in diameter was noted, and a surgical intervention was decided.%
\end{abstract}%



\sloppy


\textbf{Pneumoretroperitoneum, pneumomediastinum and neck emphysema due
to rectal diverticulosis}

\textbf{Keywords:} neck swelling; pneumomediastinum; diverticulosis.

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).\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\emph{\textbf{Figure 1A}: bleeding diverticulum twenty cm from the anal
margin (star). \textbf{1B:} two other diverticula thirty centimeter orad
from the first one (arrow).}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

\emph{\textbf{Figure 2: 2A}, free perirenal air (arrow).
\textbf{2B,}subcutaneous air bubbles (star). \textbf{2C}, neck emphysema
(arrows).}

The patient was sent for emergency surgical intervention, and she had a
segmental resection of the interested area, anastomosis and supportive
postoperative treatment. Three months after the intervention during a
follow-up, she appeared healthy and free from complaints.

The occult perforation of diverticula is a frequent cause of the
presence of free air in the abdomen, but cases of air bubbles reaching
neck structures are available as well {[}1, 2{]}.

\textbf{REFERENCES}

Besic N, Zgajnar J, Kocijancic I. Pneumomediastinum, pneumopericardium,
and pneumoperitoneum caused by peridiverticulitis of the colon: report
of a case. Dis Colon Rectum. 2004 May;47(5):766-8.

Wiles T, Mullett R, Chadwick M. Diverticular perforation: an unusual
cause of subcutaneous emphysema. Emerg Med J. 2014 Mar;31(3):259-60.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1-(composed-A-B)/Figure-1-(composed-A-B)}

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\end{figure}\selectlanguage{english}
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\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1A/Figure-1A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Figure-1B/Figure-1B}

\end{center}
\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-2-(composed-A-C)/Figure-2-(composed-A-C)}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-2B/Figure-2B}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-2C/Figure-2C}

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