Massive surgical emphysema after perineal proctosigmoidectomy

Abstract

An 83-year-old woman underwent an elective perineal proctosigmoidectomy (Altemeier procedure) for a rectal prolapse. On postoperative day 1, the patient presented with impressive subcutaneous emphysema involving the chest, neck and face without any other symptoms. A CT scan showed free air in the retroperitoneum, the intraperitoneal cavity, the mediastinum and a subcutaneous emphysema of the neck and the face. Air was also found around the coloanal anastomosis and an anastomotic leak was proven by rectal contrast agent. In this situation, a rectoscopy followed by a laparoscopy were immediately performed. The leak could not be visualised. Peritoneal lavage and drainage, followed by protective sigmoidostomy were carried out. After surgery, the follow-up was uneventful except a persistent but asymptomatic leak with a presacral cavity. The coloanal dehiscence was later proven in rectoscopy. Although sutured, it is still present and colostomy closure will eventually be possible in a few months.

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

“…Several reports have identified cases of large accumulations of pneumothorax and pneumomediastinum without direct pleural violation, including air trapping after distal extremity barotrauma, colonoscopic perforation, and perineal dissection. [1][2][3] Hamman syndrome, a spontaneous event that has similar findings to those in our patient, includes pneumomediastinum, subcutaneous emphysema, and occasionally dysphonia that can occur in association with high intrathoracic pressures, such as Valsalva during labor. 4 One mechanism postulated by Parmaksizoglu et al 2 is the creation of a one-way valve phenomenon that encourages air to entrain along natural tissue planes, which is then unable to escape.…”