Subcutaneous emphysema of thorax, neck and face after elective left colectomy: A case report

Abstract

Introduction: Anastomotic leakage is a severe complication after colorectal surgery which causes substantial morbidity and mortality and impairs the oncologic and functional outcomes. The incidence rate varies in the literature from 4% to 26%. Diagnosis is difficult. Clinical presentation and time management are closely related to prognosis. If subcutaneous emphysema is an obvious clinical sign, its etiology is complex to determine, particularly in the post-operative course of colorectal surgery.

Presentation of case: We report our experience in the management of a patient with early colorectal anastomotic leakage after left colectomy, whose only physical sign was subcutaneous emphysema of thorax, neck and face. This presentation is not described to date. Emergency CT-scan with injection of contrast revealed a pneumoperitoneum with extradigestive air in the pelvis, pneumomediastinum and subcutaneous emphysema. Suture, drainage and defunctioning ileostomy have been performed in emergency with good results. The subcutaneous emphysema resolved spontaneously without specific treatment.

Discussion: There are many differential diagnoses of subcutaneous emphysema and its etiology is potentially lethal. This case is original by the clinical manifestation of anastomotic leakage in the immediate post-operative course of colorectal surgery; this presentation is not described to date.

Conclusion: Isolated subcutaneous emphysema after left colectomy should suggest first a post-intubation tracheal wound. This case shows that an anastomotic leakage must be evocated and eliminated in order to provide the best outcome for these patients.

Fig. 1

Large subcutaneous emphysema.

Fig. 2

Pelvic pneumoperitoneum.

Fig. 3

Subphrenic pneumoperitoneum.

Fig. 4

Subcutaneous emphysema, pneumoperitoneum and pneumomediastinum.

Fig. 5

Subcutaneous emphysema, pneumoperitoneum and pneumomediastinum.

Fig. 6

Rectal opacification and anastomotic leakage on the right side.

Fig. 7

Rectal opacification and anastomotic leakage on the right side.