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Extravasation of contrast material from the descending colon (arrow).
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To confirm the perforation, a contrast enema was performed after the CT scan which showed extraluminal contrast adjacent to the descending colon (Fig. 1).
Retroperitoneal drainage through the left flank revealed a large amount of feculent discharge, necessitating a diverting loop ileostomy.
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To control the leak, a loop ileostomy was performed for diversion (Fig. 2) on hospital day 34.
Duodenal fistula was demonstrated with injection of radiopaque contrast material through a percutaneous catheter (arrow).
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A 12Fr catheter was placed through the abdominal wall and water soluble contrast injected which demonstrated a duodenal fistula (Fig. 3).