Abstract
Introduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.
Highlights
Subcutaneous emphysema is usually benign and self-limited; it may be associated with a life-threating situation
Supraclavicular subcutaneous emphysema is typically associated with a perforated gastric or duodenal ulcer, while cervical subcutaneous emphysema is usually associated with rupture of a thoracic organ or cervical esophagus or trachea
Case Reports in Surgery or due to perforated diverticulitis [3, 4]
Summary
Subcutaneous emphysema is characterized by swelling of the tissues due to accumulation and spreading of air along tissue planes. More often it suggests a communication between the subcutaneous tissue and an organ containing air (such as airway or viscera). It can be due to infection of subcutaneous tissue. Multiple perforations of the sigmoid colon were found with fistulization to the retroperitoneum and anterior lateral abdominal wall with no visible colon diverticula. These perforations were probably related to ischemic events, as ischemic colitis, leading to necrosis of the colon. The patient showed good response to the treatment, with regression of the subcutaneous emphysema, and was discharged 16 days later
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