Pneumoperitoneum, pneumoretroperitoneum, pneumo-mediastinum, pneumothorax, and extensive subcutaneous emphysema caused by wisdom tooth extraction

Abstract

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.