Damage control surgery for perforated retroperitoneal diverticulitis causing a pyomyositis

Abstract

Damage Control Surgery (DCS) is an appropriate approach to the treatment of critically ill patients with severe intraabdominal sepsis. DCS is not a surgical manoeuvre but an alternative treatment mode to primary definitive surgical care. Diverticular perforation is a common complication of diverticulitis and can lead to the creation of abscesses. A retroperitoneal abscess from colonic perforation is an unusual event, that can lead to misdiagnosis due to absence of peritoneal irritation. It requires a high index of clinical suspicion and radiological studies are needed. We present the case of a septic shock due to a perforated retroperitoneal diverticulitis also causing a pyomyositis. A DCS was performed, consisting in a sigmoidectomy, drainage of retroperitoneal infection, necrotizing pyomyositis debridement and leaving a temporary abdominal closure with the assistance of negativepressure therapy, to control the focus of the infection and in a second stage by performing a definitive surgery.