Simultaneous occurrence of pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema is rare. The most reported mechanisms are barotrauma, thermal injury and instrument puncture caused by colonoscopy. Ectopic air may travel into different body compartments through distinct anatomical fascial planes. Definite curative treatment involves surgical repair of the bowel wall defect. Conservative treatment is available in selected patients. Here, we present a case of traumatic penetrating rectal injury leading to developing air in the peritoneum, retroperitoneum, mediastinum, and subcutaneous space with good recovery under conservative treatment.
A woman with multiple calcified granulomas
Patient presentationThis 75-year-old Chinese woman is a patient of arterial hypertension, osteoporosis, chronic lower back pain, and major depression. She visited the Emergency Department for left flank pain. Yet, she denied nausea, vomiting, changed bowel pattern, dysuria or fever. On arrival, her consciousness was clear and her vital signs were all within normal limits. Physical examination disclosed an obese abdomen with a mild tenderness at the left flank but no rebounding pain. There was no tenderness at her back. Her legs were neurologically intact.X-ray was undertaken to detect suspected urolithiasis. It showed a degenerated spine with old compression fractures and multiple calcifications at both sides of the pelvis (Fig. 1). Lateral film confirmed these calcifications in the subcutaneous tissue of buttocks but not within the pelvis (Fig. 2). Urinalysis reported trace proteinuria but no hematuria. Complete blood count and chemistry panel were all within normal limits.
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