Mediastinal, retroperitoneal, and subcutaneous emphysema due to sigmoid colon penetration: A case report and literature review

Muronoi, Tomohiro; Kidani, Akihiko; Hira, Eiji; Takeda, Kayo; Kuramoto, Shunsuke; Oka, Kazuyuki; Shimojo, Yoshihide; Watanabe, Hiroaki

doi:10.1016/j.ijscr.2019.02.003

Cited by 8 publications

(12 citation statements)

References 24 publications

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“…Several case reports were reviewed by Muronoi et al 12 In these cases, retroperitoneal emphysema was also reported, while, in the current case, unlike previous reported cases, no gas was seen in the retro-or intraperitoneal spaces. It seems that because the fistula created between the intestine and the abdominal wall had no leakage to the abdominal space, no retro-or intraperitoneal emphysema occurred.…”

Section: Discussionmentioning

confidence: 46%

“…None of the cases reviewed by Oetting et al 14 and Muronoi et al 12 showed signs of infection and generalized peritonitis before the onset of the occurrence of emphysema. Similar to previous case reports, in the present case, there was no evidence of infection and generalized peritonitis during preoperative examinations.…”

Section: Discussionmentioning

confidence: 91%

“…In this condition, despite the presence of colonic perforation, diagnosis and treatment can be delayed due to the absence of peritoneal inflammation and typical complaints. 12,13 Cesarean sections are among the most-common surgical procedures increasingly performed around the world. Occurrences of adhesion bands in repeat cesarean sections and intestinal injuries have been seen, although an optimal technique for cesarean sections still exists.…”

Section: Discussionmentioning

confidence: 99%

“…For managing mediastinal emphysema, in numerous cases reviewed by Muronoi et al, 12 only a chest drain was placed. In the current case, the pneumomediastinum emphysema was managed by drainage through a collar incision.…”

Section: Discussionmentioning

confidence: 99%

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Cervical and Mediastinal Emphysema as the First Manifestation of Colonic Laceration Following Cesarean Section

Mahmodlou

Yousefiazar

2020

Journal of Gynecologic Surgery

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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)

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cervical and Mediastinal Emphysema as the First Manifestation of Colonic Laceration Following Cesarean Section

Mahmodlou

Yousefiazar

2020

Journal of Gynecologic Surgery

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“…Since 2017, there have been few reports detailing pathological colonic perforation, with only three describing extraperitoneal diverticular perforation [7,8]. Only one case reported pneumothorax and three extraperitoneal perforation after diagnostic colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal and Extraperitoneal Colonic Perforation Following Diagnostic and Therapeutic Colonoscopy with Crohn’s-related Stricture Dilation

Weng

Valencia

Krudy

et al. 2020

Cureus

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Colonic perforation is an uncommon but known and feared complication of colonoscopy, which carries a high mortality rate. We present an uncommon case of extensive intra-and extraperitoneal air following colonic perforation in a patient undergoing inpatient colonoscopy for evaluation of unintentional weight loss and constipation. During colonoscopy, a splenic flexure stricture was identified and dilated. Postprocedural hemodynamic instability prompted further imaging which revealed pneumoperitoneum, bilateral pneumothorax, pneumomediastinum, pneumopericardium, and severe subcutaneous emphysema. Emergent exploratory laparotomy found perforation of the proximal transverse colon which required resection and transverse colostomy placement. The patient also underwent bilateral chest tube placement and was treated with antibiotics for peritonitis. The patient was eventually diagnosed with Crohn's disease and discharged to an extended care facility with outpatient follow-up. Extraperitoneal colonic perforations are fairly rare, and to our knowledge, we present the most severe case that has been published in recent years.

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Clinical progress note: Life‐threatening side effects of targeted therapies for solid tumors

Thomas

Brondfield

2022

Journal of Hospital Medicine

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Mediastinal, retroperitoneal, and subcutaneous emphysema due to sigmoid colon penetration: A case report and literature review

Abstract: Highlights Massive mediastinal emphysema is rare signs of colon perforation. The diagnosis may be delayed due to the absence of peritoneal irritation. Laparotomy should be considered in case of colonic penetration with the mediastinum emphysema.

Cited by 8 publications

References 24 publications

Cervical and Mediastinal Emphysema as the First Manifestation of Colonic Laceration Following Cesarean Section

Cervical and Mediastinal Emphysema as the First Manifestation of Colonic Laceration Following Cesarean Section

Intraperitoneal and Extraperitoneal Colonic Perforation Following Diagnostic and Therapeutic Colonoscopy with Crohn’s-related Stricture Dilation

Clinical progress note: Life‐threatening side effects of targeted therapies for solid tumors

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