Widespread surgical emphysema following trivial injury to the hand

A 23-year-old glazer presented to the A&E department with pain in his left arm following a 2 mm puncture injury to his left thenar eminence. Examination showed crepitus throughout the arm and over the chest wall. Plain X-rays confirmed extensive surgical emphysema but no evidence of pneumothorax. Clinical observations and laboratory markers for infection were normal. The patient was prescribed broad spectrum antibiotics for presumed gas-producing organism infection. After 24 h cultures returned negative and no other signs of infection were detected. Treatment was discontinued and the patient was allowed home. Several days later he experienced severe diarrhoea and as a result required time off work. No cause was found on investigation. We postulate a benign aetiology for the surgical emphysema in this case. In future it may be possible to recognise benign surgical emphysema at presentation and avoid prescribing unnecessary antibiotics.