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Our patient sustained a laceration of the membranous portion of the trachea associated with massive subcutaneous emphysema after an apparently uneventful intubation. The patient was successfully operated on within seven hours. The importance of prompt diagnosis and treatment in the event of this rare complicatoin and the different causative factors are discussed.
A case of colonoscopic polypectomy complicated by perforation, pneumoperitoneum, bilateral pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema is presented. The anatomic basis for the various clinical presentations of extraluminal air following colonoscopy as well as the option of conservative therapy of select cases of perforation is discussed.
A 69-year-old male underwent endoscopic mucosal resection for an early gastric cancer under general anesthesia with sevoflurane and nitrous oxide. Because of gastro-intestinal gas insufflation for endoscopic visualization, abdominal distension was found remarkable and the peak inspiratory pressure increased from 20 cmH2O to 30 cmH2O. About 2.5 hours after initiation of the procedure, iatrogenic perforation was identified endoscopically and emphysema became apparent not only in the scrotum, but also in the subcutaneous tissues of the chest and neck. In order to ameliorate this complication, an emergent distal gastrectomy was performed involving laparotomy. Nitrous oxide should be avoided in endoscopic mucosal resection under general anesthesia to prevent intestinal distension and attention should be paid to subcutaneous emphysema as a sign of perforation of the gastro-intestinal tract.
The occurrence of associated intraperitoneal and retroperitoneal colonic perforation is uncommon after colonoscopy. We report a case of this complication revealed by subcutaneous emphysema, pneumomediastinum, pneumoperitoneum and retro-pneumoperitoneum after colonic mucosectomy.
A case of retroperitoneal, mediastinal, and subcutaneous emphysema following rectal surgery is described. This complication has not been reported in medical literature. Treatment was based on the fear of a more extensive and irreversible situation, because on the basis of the single case, it could not be demonstrated that the intestinal gas was not associated with infection.
Percutaneous insertion of permanent pacemaker leads through the subclavian vein is an alternative to the cephalic vein approach. A rare occurrence and successful conservative management of extensive pneumomediastinum and subcutaneous emphysema without concomitant pneumothorax resulting from permanent transvenous pacemaker insertion in an 80-year-old man with syncope and arrhythmia is reported.
We describe a case of subcutaneous cervicofacial emphysema in a 21-year-old man who had undergone endotracheal intubation while under general anesthesia 2 months earlier. The emphysema had arisen on the right side of the face and neck and extended to the right shoulder and the cubital fossa. The patient was hospitalized and treated with parenteral antibiotics and hyperbaric oxygen. On hospital day 10, he had improved sufficiently to warrant discharge on the next day. Two months later, the patient presented at a follow-up visit with a recurrence, and he was readmitted. By hospital day 28, his condition had improved and he was scheduled for discharge. However; he experienced another recurrence just before he was to leave the hospital. The circumstances of this second recurrence led us to suspect that the patient was able to produce these signs and symptoms on his own. He was referred for psychiatric evaluation, and findings were negative. He was then sent to the Ear Nose, and Throat Service, where we confirmed that his subcutaneous emphysema could be brought on by Valsalva's maneuver. We performed suspension laryngoscopy and detected two orifices of fistular tracts next to the right vallecula and three at the root of the epiglottis. We repaired the injured mucosa and the orifices of the fistulae with absorbable sutures and cauterized the area. The swelling resolved completely within 4 days, and findings on a radiographic examination of the chest and neck 1 week later were normal. The patient was then lost to follow-up. The presence of air in the retropharyngeal and cervical subcutaneous spaces of the neck and shoulder without pneumomediastinum is an uncommon complication of endotracheal intubation. We discuss the clinical and radiographic findings associated with this complication, and we review diagnostic considerations and management.
Essential prerequisite of laparoscopic operation is establishing and maintaining pneumoperitoneum with a certain pressure. But under certain circumstances CO2-gas insufflating could induce pneumothorax, pneumomediastinum and subcutaneous emphysema during the operation. to probe the mechanism of the above complications. 2 typical cases were reported with attempt to probe the mechanism of the development of such applications. We believe that high intra-abdominal pressure during operation is the primary cause of the complications. The essentials of prevention and management of such complications were proposed.
A case of subcutaneous emphysema following intraoral elimination of plaque and tooth shading, on a bridge fixed on implants, is presented. An instrument that produces a cleaning spray with a water-air-powder mixture was used. A few minutes after this cleaning procedure there was facial swelling. The patient experienced difficulties in breathing and in swallowing; symptoms of unilateral hearing loss were also noticed. The emphysema lasted for three days. Etiology, diagnosis, differential diagnosis, complications and management are discussed.
Fibreoptic sigmoidoscopy is a commonly used technique. However, it is not without complications. We report the rare occurrence of subcutaneous emphysema, mediastinal emphysema, and pneumoperitoneum following routine sigmoidoscopy.
A full-term newborn infant with severe subcutaneous emphysema of the skull as a complication of vacuum extraction and scalp electrode wound is reported. We hypothesize that detachment of subcutaneous tissue and transmission of the negative pressure associated with the vacuum extraction resulted in entry of air through the scalp electrode wound.
An extremely rare case of cavitating large cell carcinoma lung is reported in a middle aged man who developed pneumomediastinum, pneumothorax and subcutaneous emphysema on thirteenth day of his tele cobalt radiotherapy to chest. Possible mechanisms of such complications during radiotherapy are also discussed.
A 40-year-old woman with known systemic sclerosis presented with dyspnea. She had been treated for pneumonia, 2 months prior to the present admission and at this time presented with sudden dyspnea and was found to have a spontaneous pneumomediastinum and subcutaneous emphysema. Pneumomediastinum is an extremely rare complication in patients with systemic sclerosis.
Six children with a foreign body in the airway presented with progressive subcutaneous emphysema as a clinical feature. The aim of this report is to highlight this unusual clinical presentation of foreign body in the tracheobronchial tree. A peculiar arrangement of fascial planes in the neck, chest, and abdomen and an excessive pressure gradient at the alveolar level, facilitates extraalveolar migration of air in the subcutaneous tissue.
Pneumatosis intestinalis (PI) occurred in a pediatric liver transplant recipient experiencing chronic rejection. Signs and symptoms included abdominal distention, subcutaneous emphysema, fever, and malaise. Antibiotic treatment and nasogastric decompression resulted in prompt relief of symptoms, and surgery was not necessary. The etiology, pathophysiology, and therapy of this rare condition are discussed.
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