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Extensive Subcutaneous Emphysema as a Presentation of Ischemic Colitis.

Carvalho AF, Branco C, Leão P, Antunes C - Case Rep Surg (2015)

Bottom Line: Introduction.Case Report.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Hospital of Braga, 4710-243 Braga, Portugal ; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory, Guimarães, 4710-057 Braga, Portugal.

ABSTRACT
Introduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.

No MeSH data available.


Related in: MedlinePlus

(a) Thoracic and abdominal (asterisk) subcutaneous emphysema and retroperitoneal gas (arrow). (b) Cervical subcutaneous emphysema (asterisk). (c) Thoracic subcutaneous emphysema (asterisk) and pneumomediastinum (arrow). (d) Abdominal subcutaneous emphysema (asterisk) and retroperitoneal gas (arrow).
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Related In: Results  -  Collection


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fig1: (a) Thoracic and abdominal (asterisk) subcutaneous emphysema and retroperitoneal gas (arrow). (b) Cervical subcutaneous emphysema (asterisk). (c) Thoracic subcutaneous emphysema (asterisk) and pneumomediastinum (arrow). (d) Abdominal subcutaneous emphysema (asterisk) and retroperitoneal gas (arrow).

Mentions: A 93-year-old woman presented to the emergency department with malaise, progressive asthenia, and anorexia for 2 weeks and abdominal pain for 2 days. At physical examination, extended thoracic subcutaneous emphysema as well as cervical and abdominal subcutaneous emphysema was noted. The patient showed mild tenderness in the lower left abdominal quadrant. Computed tomography revealed subcutaneous emphysema in cervical, thoracic, and abdominal segments (∗ in Figures 1(a)–1(d)). Moreover, gas in the retroperitoneum (arrows in Figures 1(a) and 1(d)) and pneumomediastinum (arrow in Figure 1(c)) was also visible. Images suggested a perforation of the sigmoid colon. An exploratory laparotomy was performed. Intraoperatively, multiple perforations of the sigmoid colon were found with fistulization to the retroperitoneum and anterior lateral abdominal wall with no visible colon diverticula. These perforations were probably related to ischemic events, as ischemic colitis, leading to necrosis of the colon. Resection of the sigmoid colon and an end colostomy were performed. Postoperatively, the patient showed good response to the treatment, with regression of the subcutaneous emphysema, and was discharged 16 days later.


Extensive Subcutaneous Emphysema as a Presentation of Ischemic Colitis.

Carvalho AF, Branco C, Leão P, Antunes C - Case Rep Surg (2015)

(a) Thoracic and abdominal (asterisk) subcutaneous emphysema and retroperitoneal gas (arrow). (b) Cervical subcutaneous emphysema (asterisk). (c) Thoracic subcutaneous emphysema (asterisk) and pneumomediastinum (arrow). (d) Abdominal subcutaneous emphysema (asterisk) and retroperitoneal gas (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4664795&req=5

fig1: (a) Thoracic and abdominal (asterisk) subcutaneous emphysema and retroperitoneal gas (arrow). (b) Cervical subcutaneous emphysema (asterisk). (c) Thoracic subcutaneous emphysema (asterisk) and pneumomediastinum (arrow). (d) Abdominal subcutaneous emphysema (asterisk) and retroperitoneal gas (arrow).
Mentions: A 93-year-old woman presented to the emergency department with malaise, progressive asthenia, and anorexia for 2 weeks and abdominal pain for 2 days. At physical examination, extended thoracic subcutaneous emphysema as well as cervical and abdominal subcutaneous emphysema was noted. The patient showed mild tenderness in the lower left abdominal quadrant. Computed tomography revealed subcutaneous emphysema in cervical, thoracic, and abdominal segments (∗ in Figures 1(a)–1(d)). Moreover, gas in the retroperitoneum (arrows in Figures 1(a) and 1(d)) and pneumomediastinum (arrow in Figure 1(c)) was also visible. Images suggested a perforation of the sigmoid colon. An exploratory laparotomy was performed. Intraoperatively, multiple perforations of the sigmoid colon were found with fistulization to the retroperitoneum and anterior lateral abdominal wall with no visible colon diverticula. These perforations were probably related to ischemic events, as ischemic colitis, leading to necrosis of the colon. Resection of the sigmoid colon and an end colostomy were performed. Postoperatively, the patient showed good response to the treatment, with regression of the subcutaneous emphysema, and was discharged 16 days later.

Bottom Line: Introduction.Case Report.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Hospital of Braga, 4710-243 Braga, Portugal ; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory, Guimarães, 4710-057 Braga, Portugal.

ABSTRACT
Introduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.

No MeSH data available.


Related in: MedlinePlus