An unusual cause of neck cellulitis
===================================

* George Rakovich
* Bartosz Adamowicz
* Alexandre Dugas

A 55-year-old woman was admitted to hospital after presenting to the emergency department with erythema and moderate swelling, and tenderness above her left sternoclavicular joint (Figure 1A), which had started 3 days previously. She was afebrile and her vital signs were normal. Her leukocyte count was normal and her C-reactive protein level was 46.5 (normal < 5.0) mg/L.

![Figure 1:](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/195/43/E1482/F1.medium.gif)

[Figure 1:](http://www.cmaj.ca/content/195/43/E1482/F1)

Figure 1: 
(A) Cellulitis of the neck from colonic diverticulitis in a 55-year-old woman with previous reconstruction of esophageal atresia using a segment of colon. (B) A contrast-enhanced computed tomography scan showed findings typical of diverticulitis, including a fluid-filled false diverticulum (arrow), bowel wall thickening, subcutaneous fat stranding and edema.

The patient had noted dysphagia for a few days and had a history of esophageal atresia that had been managed with interposition of a section of colon between the cervical esophagus and stomach when she was 2 years old. She had also undergone repair of a nonspecified congenital heart defect via median sternotomy and, more recently, she had had a left shoulder replacement for degenerative disease of the glenohumeral joint.

Because of the proximity of prosthetic material and previous operative fields to the area of erythema, we were concerned about a deep space infection extending to the skin. A computed tomography (CT) scan of the neck showed soft-tissue swelling, thickening of the digestive tract wall and a fluid-filled, edematous outpouching of the digestive tract (Figure 1B). The outpouching had been visible on a CT scan 2 years previously, when it was suggestive of an uncomplicated false diverticulum of the colon. Endoscopy showed a mild inflammatory narrowing of the esophagocolonic anastomosis, and a pit in the colonic wall just below. We diagnosed colonic diverticulitis.

The patient had been started empirically on intravenous piperacillin–tazobactam (3.375 g every 6 h) at the time of admission, and we continued this for 8 days after the diagnosis. The patient was asymptomatic at an outpatient follow-up a month later.

Since the colon maintains its histological identity when transposed to a different anatomic region, it remains vulnerable to pathologic processes that affect it in its usual position, including cancer and diverticular disease.1,2 Over time, a transposed colon may develop intrathoracic redundancy, as well as motility and emptying issues, which may contribute to the development of pulsion diverticula.3 The risk of recurrence of diverticulitis in a transposed colon is not known.

## Footnotes

*   **Competing interests:** George Rakovich reports funding from TransMedTech Institute. No other competing interests were declared.

*   This article has been peer reviewed.

*   The authors have obtained patient consent.

*   **Dedication:** The authors wish to dedicate this paper to the memory of Dr. Serge Dubé (1950–2023), professor of surgery, mentor and inspiration to generations of medical students and residents.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: [https://creativecommons.org/licenses/by-nc-nd/4.0/](https://creativecommons.org/licenses/by-nc-nd/4.0/)

## References

1.  Sterpetti AV, Sapienza P. Adenocarcinoma in the transposed colon: High grade active inflammation versus low grade chronic inflammation. Eur J Surg Oncol 2019;45:1536–41.
    
    

2.  Punwani VV, Ong E, Hii MW. Cervical diverticulitis: a novel complication of a neonatal colonic interposition graft following oesophagectomy. BMJ Case Rep 2015;2015:bcr2015211711.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTE6ImNhc2VyZXBvcnRzIjtzOjU6InJlc2lkIjtzOjI2OiIyMDE1L3NlcDA5XzEvYmNyMjAxNTIxMTcxMSI7czo0OiJhdG9tIjtzOjIzOiIvY21hai8xOTUvNDMvRTE0ODIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  Dantas RO, Mamede RC. Motility of the transverse colon used for esophageal replacement. J Clin Gastroenterol 2002;34:225–8.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=11873100&link_type=MED&atom=%2Fcmaj%2F195%2F43%2FE1482.atom)