Massive Retroperitoneal and Subcutaneous Emphysema after Transanal Excision of Rectal Cancer

Abstract

Transanal excision (TAE) is considered a safe, alternative approach for patients with early stage of rectal cancer. Complications associated with TAE are rare, such as bleeding, perforation, incontinence, and rectal stricture. Subcutaneous emphysema is early complication of laparoscopic surgery, common during upper gastrointestinal and gynecological surgery. We report a case of retroperitoneal and subcutaneous emphysema emerging after TAE of rectal tumor. The patient presented with changed bowel habits. Colonoscopy with pathology reports, ultrasound, and magnetic resonance imaging showed an adenocarcinoma in the rectum at a 5 cm from the anus and did not reveal signs of invasive growth, pathologic lymph nodes, or systemic metastases. After surgery patient complained about abdominal pain and severe subcutaneous emphysema. Computed tomography showed retroperitoneal emphysema with no signs of rectal wall defect. He received antibiotics and was kept hospitalized with a solid diet and the retroperitoneal air disappeared on the thoracic X-ray. Patients who remain clinically stable or steadily improving without signs if peritonitis can be managed conservatively. Only in case of ineffectiveness of conservative therapy, undergo surgery.

Keywords: Rectal cancer; Subcutaneous emphysema; Transanal excision.

Fig. 1

Pelvis magnetic resonance tomogram showing the tumor (arrows).

Fig. 2

CT scan. a Abdominal CT scan showing intraperitoneal air surrounding the liver (arrow). b Abdominal CT scan showing retroperitoneal air surrounding the right kidney (arrow). c Abdominal CT scan showing subcutaneous air (arrow). CT, computed tomography.