Attending Physician Vanderbilt University Nashville, Tennessee, United States
Case Diagnosis: 66-year-old male presenting with acute, progressive right groin/hip/back pain with an emergency department evaluation ultimately findings acute sigmoid diverticulitis with macroperforation, extraperitoneal abdominal abscess formation, RLQ body wall abscess formation and colovesicular fistilization, treated with antibiotics and IR drained for RLP abdominal abscess.
Case Description: Our patient presented as a self-referral with two weeks of right groin, hip and low back pain without inciting event or injury. His pain was 9/10, constant, sharp, located in the groin with radiation to his hip and back. Movement and functionality were significantly limited secondary to pain, however, no gross neurologic deficits were reported. He noted a groin mass with associated swelling, erythema down his inner thigh to his knee. Standing and coughing worsened pain without relief provided by NSAIDs. Review of systems was negative other than subjective chills, mild diarrhea over the past few days. Physical exam was pertinent for a non-reducible right anterior inguinal mass and a palpable cord along the anterior thigh. The mass was tender and worsened with standing and motion. He remained neurologically intact in the lower extremities. With this presentation, the patient was emergently transferred to the ED for further workup and evaluation.
Discussions: Although exceedingly uncommon, there have been case reports of perforated diverticular disease presenting with hip pain. 1,2,3,4 Raising awareness, knowing these cases have presented to spine orthopedic clinics is helpful for diagnosis and proper treatment.
Conclusions: This case shares a common presenting orthopedic complaint with an atypical etiology intended to raise awareness. Diverticulitis, with subsequent abscess formation and fistulization, presenting with groin/hip/back pain can seem consistent with multiple musculoskeletal diagnosis, which can delay workup. The combination of awareness, the utilization of red-flags symptoms, and outlying physical exam findings can assist in timely diagnosis and successful treatment.