Tension faecopneumothorax: a rare presentation of colonic diverticular perforation

Tension faeco-pneumothorax is rare, typically occurring following strangulation of a diaphragmatic hernia. We report the case of a 69-year-old gentleman with a previous history of thoraco-abdominal oesophagectomy, who presented with an acute abdomen and respiratory distress. Initial investigations revealed pneumoperitoneum and left-sided pneumothorax. The patient rapidly deteriorated with development of tension pneumothorax. Following tube thoracostomy, feculent fluid was drained. At laparotomy, gross faecal peritonitis secondary to colonic diverticular perforation was encountered, with no evidence of intestinal diaphragmatic herniation. This case report highlights the rarity of this clinical entity as well as the possible complications of hiatal surgery.