Background: One of the most common surgical procedures, cesarean section, can cause adhesion bands in the abdomen. Intestinal injury is a complication of repeat cesarean sections, particularly in the presence of adhesion bands. Occurrence of extensive cervical, subcutaneous, and mediastinal emphysema following colon perforation is a rare condition. This report presents a very rare case of cervical and mediastinal emphysema as the primary sign following colon perforation caused by a cesarean section. Case: A 27-year-old woman undergoing cesarean section was referred to an emergency room due to crepitus palpation. A physical examination revealed that she had ''snowball'' crepitation in her neck and upper chest. A chest-X ray revealed that she had mediastinal emphysema. In an abdominal exploration, her sigmoid colon was found sticking to her abdominal wall in the left corner of a Pfannenstiel incision while that colon had a small laceration and fistula to the abdominal wall. The sigmoid colon was released from the fascia and repaired with some Gambee stitches. Then, the pneumomediastinum space was drained from her neck by a collar incision. Results: The patient's granulation tissue gradually appeared at the incision line over the intestine and lateral wound. The skin in the upper and lower parts of the midline incision were approximated, and the lateral wound was left open for spontaneous closure. A few days after the surgery, the subcutaneous and mediastinal emphysema disappeared. She was discharged with instructions on taking a daily bath and dressing the lateral surgical wound. After 4 weeks, the lateral surgical wound had closed. Conclusions: Adhesion bands occur in repeat cesarean sections due to intestinal injuries, even though an optimal technique is used. A sufficient pressure gradient between the intestinal duct and the subcutaneous space following perforation and the presence of dead spaces in fascia resulting in surgical wounds are important factors in development of subcutaneous emphysema due to intestinal perforation. (J GYNECOL SURG 36:94)