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. 2016 Dec;32(6):234-238.
doi: 10.3393/ac.2016.32.6.234. Epub 2016 Dec 31.

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection

Hee Cheul Jung  1 , Hyun Jin Kim  1 , Sung Bok Ji  1 , Jun Hyeong Cho  1 , Ji Hye Kwak  1 , Chang Min Lee  1 , Wan Soo Kim  1 , Jin Ju Kim  1 , Jae Min Lee  1 , Sang Su Lee  1
Affiliations

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection

Hee Cheul Jung et al. Ann Coloproctol. 2016 Dec.

Abstract

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.

Keywords: Colonoscopy; Perforation; Pneumomediastinum; Pneumoretroperitoneum; Subcutaneous emphysema.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Colonoscopic finding. (A) Endoscopic mucosal resection site of the sigmoid colon. No definite perforation is seen. (B) Prophylactic clipping and hot biopsy coagulation were done.
Fig. 2
Fig. 2. Abdomen X-ray and abdominal computed tomography (CT) findings. (A) Diffuse bilateral retroperitoneal air is seen on an X-ray of the abdomen. (B) Retroperitoneal air at the perinephric area was seen on abdominal CT. No subdiaphragmatic air was seen.
Fig. 3
Fig. 3. Follow-up chest and abdominal X-ray findings. (A, B) Pneumoretroperitoneum and pneumomediastinum were improved after medical treatment.
See this image and copyright information in PMC

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