PMC4897038_01
73-year-old woman with abdominal pain. Scout image from the outpatient CT shows displacement of descending colon and proximal sigmoid (arrows) from the normal position in the iliac fossa.
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Eight days prior to her presentation in the emergency department, she had an abdominal computed tomography (CT) scan to evaluate an abdominal mass incidentally noted on routine physical exam by her primary care physician (Figure 1, Figure 2, Figure 3).
73-year-old woman with abdominal pain. Axial CT of lower abdomen shows a large mass (black arrows) encasing the colon (white arrow) near the junction of the descending and sigmoid portions.
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Eight days prior to her presentation in the emergency department, she had an abdominal computed tomography (CT) scan to evaluate an abdominal mass incidentally noted on routine physical exam by her primary care physician (Figure 1, Figure 2, Figure 3).
73-year-old woman with abdominal pain. Coronal reconstruction of CT shows mass extending from colon and invading into anterior abdominal wall. Arrows indicate the point of exit of mass through the abdominal wall musculature.
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Eight days prior to her presentation in the emergency department, she had an abdominal computed tomography (CT) scan to evaluate an abdominal mass incidentally noted on routine physical exam by her primary care physician (Figure 1, Figure 2, Figure 3).
73-year-old woman with abdominal pain. Scout image of CT on admission shows a radiolucent area over left iliac fossa (arrows) that suggests a focus of gas.
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A repeat CT scan done at that time confirmed the previously noted mass as well as new, irregularly-marginated gas and fluid collections both deep and superficial to the anterior abdominal wall muculature (Figure 4, Figure 5).
73-year-old woman with abdominal pain. Axial CT shows irregularly marginated focus of gas (arrows) superficial to the abdominal wall musculature, compatible with abscess.
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A repeat CT scan done at that time confirmed the previously noted mass as well as new, irregularly-marginated gas and fluid collections both deep and superficial to the anterior abdominal wall muculature (Figure 4, Figure 5).
73-year-old woman with abdominal pain. Axial CT shows the tip of one pigtail catheter (black arrow) located within the superficial abscess and another pigtail catheter (white arrow) located within the deeper pelvic abscess.
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CT guidance and a total of 30cc of fluid was drained (Fig. 6). Cultures of the fluid grew Escherichia coli and Micrococcus species.
73-year-old woman with abdominal pain. Axial CT shows contrast (arrows) within the enterocutaneous fistula and spilling out onto skin.
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Concurrently, a 1 cm wide fistulous tract formed around the drains so that fecal material spilled from the skin and the drains fell out (Fig. 7).
73-year-old woman with abdominal pain. Scout of CT showing the location of the groin crease (black arrows), with the external stoma device (white arrows) lying across the lateral portion of the crease.
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However, due to the location of the fistulous opening near the groin crease, a seal could not be maintained and there was continuous leakage (Fig. 8).