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Pneumomediastinum and Subcutaneous Emphysema Secondary to Polypectomy

Dong, Jinpei MD1; Wang, Huahong MS1

American Journal of Gastroenterology: October 2019 - Volume 114 - Issue 10 - p 1569
doi: 10.14309/ajg.0000000000000233
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1Departments of Gastroenterology, Peking University First Hospital, Beijing, China.

Correspondence: Huahong Wang. E-mail: wwwanghuahong@163.com.

Received December 13, 2018

Accepted March 14, 2019

Online date: May 31, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

A 76-year-old man was referred to our institution with intermittent hematochezia for the previous 2 months. He had no specific medical history except for well-controlled hypertension diagnosed 5 years earlier. A diagnostic colonoscopy was performed and a lateral spreading tumor of diameter 30 mm in the sigmoid colon (a) was removed by endoscopic mucosal resection. Several hours later, the patient complained of chest pain, and physical examination revealed subcutaneous emphysema of his upper chest and neck. He denied abdominal pain, and abdominal examination was unremarkable for peritoneal irritation sign. Laboratory tests showed a white blood cell count of 13.1 × 109/L, a hemoglobin level of 140 g/L, and a high sensitive C-reactive protein of 183.52 mg/L. A computed tomography scan of the abdomen showed intraabdominal free gas (b). A computed tomography scan of the thorax revealed pneumomediastinum and subcutaneous emphysema of chest and neck (c,d). The patient remained clinically stable and afebrile with the leukocytosis improving after receiving antibiotics and parenteral nutrition over the next 5 days. Pneumomediastinum and subcutaneous emphysema are extremely rare complications of colonic perforation, where free air enters the retroperitoneum and passes along the fascial planes, large vessels, and mesentery to enter the mediastinum and subcutaneous tissues. (Informed consent was obtained from the patient to publish these images.)

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