Massive surgical emphysema after perineal proctosigmoidectomy

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Complications

Background:

• Rectal prolapse is a condition where the rectal lining protrudes from the anus.
• The Altemeier procedure is a surgical option for rectal prolapse, involving perineal proctosigmoidectomy.
• Postoperative complications require prompt diagnosis and management.

Observation:

• An 83-year-old woman developed extensive subcutaneous emphysema of the chest, neck, and face on postoperative day 1 after an Altemeier procedure.
• CT imaging revealed free air in the retroperitoneum, intraperitoneal cavity, mediastinum, and subcutaneous tissues.
• Air was noted around the coloanal anastomosis, with rectal contrast confirming an anastomotic leak.

Findings:

• Despite rectoscopy and laparoscopy, the leak's origin was not visualized.
• Initial management included peritoneal lavage, drainage, and a protective sigmoidostomy.
• Follow-up revealed a persistent, asymptomatic presacral cavity and confirmed coloanal dehiscence, which was later sutured.

Implications:

• Anastomotic leaks after colorectal surgery can present with unusual signs like widespread emphysema.
• Early recognition and surgical intervention are crucial for managing such complications.
• Persistent coloanal dehiscence may require delayed stoma closure, highlighting the need for long-term follow-up.