Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Aug 27;6(8):160-3.
doi: 10.4240/wjgs.v6.i8.160.

Massive surgical emphysema following transanal endoscopic microsurgery

Geert Aam Simkens  1 , Simon W Nienhuijs  1 , Misha Dp Luyer  1 , Ignace Hjt de Hingh  1
Affiliations
Case Reports

Massive surgical emphysema following transanal endoscopic microsurgery

Geert Aam Simkens et al. World J Gastrointest Surg. .

Abstract

We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed massive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery (TEM) procedure for a rectal intramucosal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal contrast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO2 gas in the rectum during the TEM-procedure. Conservative treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we expect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice.

Keywords: Colorectal neoplasms; Gastrointestinal endoscopy; Intraperitoneal emphysema; Microsurgery; Retropneumoperitoneum; Subcutaneous emphysema; Transanal endoscopic microsurgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Right-sided peri-orbital subcutaneous emphysema directly postoperative (arrow).
Figure 2
Figure 2
Thoracic X-ray suggesting free intraperitoneal air beneath the left diaphragm (arrow).
Figure 3
Figure 3
Computed tomography-scan. A: Abdominal computed tomography-scan showing retroperitoneal air surrounding the left kidney (arrow); B: Pelvic computed tomography-scan with rectal contrast showing free air in the mesorectum (arrow).
See this image and copyright information in PMC

References

    1. Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H. [A system for a transanal endoscopic rectum operation] Chirurg. 1984;55:677–680. - PubMed
    1. Léonard D, Remue C, Kartheuser A. The transanal endoscopic microsurgery procedure: standards and extended indications. Dig Dis. 2012;30 Suppl 2:85–90. - PubMed
    1. Bignell MB, Ramwell A, Evans JR, Dastur N, Simson JN. Complications of transanal endoscopic microsurgery (TEMS): a prospective audit. Colorectal Dis. 2010;12:e99–103. - PubMed
    1. Cantos M, Bruna M, García-Coret MJ, Villalba FL, Roig JV. [Pneumomediastinum and subcutaneous emphysema like strange complications after transanal endoscopic microsurgery] Rev Esp Enferm Dig. 2009;101:445–446. - PubMed
    1. Franken RJ, Moes DE, Acherman YI, Derksen EJ. Free Intra-Abdominal Air without Peritoneal Perforation after TEM: A Report of Two Cases. Case Rep Surg. 2012;2012:185429. - PMC - PubMed

Publication types

LinkOut - more resources