Pathways of Extrapelvic Spread of Disease

  • Morton A. Meyers


Diseases arising from the pelvic contents may first manifest themselves by signs and symptoms remote from their source of origin. Gastrointestinal tract perforations, in particular, may dissect along anatomic planes of the pelvis to first present in the buttock, hip, thigh, and even the lower leg and the retroperitoneal space of the abdomen. Pain, mass, or crepitation at these sites may be very misleading since the origin of the underlying inflammatory condition or the neoplastic, traumatic, or foreign body perforation of the bowel within the pelvis often remains clinically occult. Radiologic evaluation may be crucial in redirecting the diagnostic and therapeutic approach as well as in documenting the extent of disease.


Septic Arthritis Necrotizing Fasciitis Subcutaneous Emphysema Piriformis Muscle Sigmoid Diverticulitis 
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  1. 1.
    Meyers MA, Goodman KJ: Pathways of extrapelvic spread of disease: Anatomic-radiologic correlation. AJR 125: 900–909, 1975CrossRefGoogle Scholar
  2. 2.
    Edwards JD, Eckhauser FE: Retroperitoneal perforation of the appendix presenting as subcutaneous emphysema of the thigh. Dis Colon Rectum 29(7): 456–458, 1986PubMedCrossRefGoogle Scholar
  3. 3.
    Fiss TW Jr, Cigtay OS, Miele AJ, et al: Perforated viscus presenting with gas in the soft tissues (subcutaneous emphysema). AJR 125: 226–233, 1975CrossRefGoogle Scholar
  4. 4.
    Korsten J, Mattey WE, Bastidas J, et al: Subcutaneous emphysema of the thigh secondary to ruptured diverticulum of the ascending colon. Radiology 106: 555–556, 1973PubMedGoogle Scholar
  5. 5.
    Linscheid RI, Kelly PJ, Symmonds RE: Emphysematous cellulitis of the hip and thigh resulting from enteric fistula. J Bone J Surg 45: 1691–1697, 1963Google Scholar
  6. 6.
    Mzabi R, Himal HS, MacLean LD: Gas gangrene of the extremity: The presenting clinical picture in perforating carcinoma of the caecum. Br J Surg 62: 373–374, 1975PubMedCrossRefGoogle Scholar
  7. 7.
    Pickels RF, Karmody AM, Tspogas MJ, et al: Subcutaneous emphysema of the lower extremity of gastrointestinal origin: Report of a case. Dis Colon Rectum 17: 82–86, 1974PubMedCrossRefGoogle Scholar
  8. 8.
    Oetting HK, Kramer NE, Branch WE: Subcutaneous emphysema of gastrointestinal origin. Am J Med 19: 872–886, 1955PubMedCrossRefGoogle Scholar
  9. 9.
    Quigley JP, Brody DA: A physiologic and clinical consideration of pressures developed in the digestive tract. Am J Med 13: 73–81, 1952PubMedCrossRefGoogle Scholar
  10. 10.
    Burt CV: Pneumatic rupture of intestinal canal with experimental data showing mechanism of perforation and pressure required. Arch Surg 22: 875–902, 1931CrossRefGoogle Scholar
  11. 11.
    Ainsworth J: Emphysema of the leg following perforation of the pelvic colon or rectum. Br J Radiol 32: 54–55, 1959PubMedCrossRefGoogle Scholar
  12. 12.
    Altemeier WA, Alexander JW: Retroperitoneal abscess. Arch Sug 83: 512–524, 1961CrossRefGoogle Scholar
  13. 13.
    Shaffer RD: Subcutaneous emphysema of the leg secondary to toothpick ingestion. Arch Surg 99: 542–545, 1969PubMedCrossRefGoogle Scholar
  14. 14.
    Meshkov SL, Seltzer SE, Finberg HJ: CT detection of intraabdominal disease in patients with lower extremity signs and symptoms. J Comp Assist Tomogr 6(3): 497–501, 1982CrossRefGoogle Scholar
  15. 15.
    Smith WS, Ward RM: Septic arthritis of the hip complicating perforation of abdominal organs. JAMA 195: 170–172, 1966Google Scholar
  16. 16.
    Abratt RP, Pontin AR, Roman TE, et al: Tumour spread through the obturator foramen. Br J Radiol 58: 673–674, 1985PubMedCrossRefGoogle Scholar
  17. 17.
    Rao BK, Lange TA, Hafez GR, et al: Extension of recurrent rectal carcinoma through sciatic foramen: Diagnosis by computed tomography. Comp Radiol 6: 193–197, 1982CrossRefGoogle Scholar
  18. 17a.
    Smith HJ, Berk RN, Janes JO, et al: Unusual fistulae due to colonic diverticulitis. Gastrointest Radiol 2: 387–392, 1978PubMedCrossRefGoogle Scholar
  19. 18.
    Meyers MA: Acute extraperitoneal infection. Semin Roentgenol 8: 445–464, 1973PubMedCrossRefGoogle Scholar
  20. 19.
    Meyers MA: Radiologic features of the spread and localization of extraperitoneal gas and their relationship to its source: An anatomical approach. Radiology 111: 17–26, 1974PubMedGoogle Scholar
  21. 20.
    Meyers MA, Whalen JP, Peelle K, et al: Radiologic features of extraperitoneal effusions: An anatomic approach. Radiology 104: 249–257, 1972PubMedGoogle Scholar
  22. 21.
    Illescas FF, Baker ME, McCann R, et al: CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR 146: 1289–1292, 1986PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Morton A. Meyers
    • 1
  1. 1.Department of Radiology, School of MedicineState University of New York at Stony BrookStony BrookUSA

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