Pneumomediastinum as a complication of colon perforation - a case report

Colon perforation is most common in patients with colorectal cancer and diverticulitis. It is one of the causes of the so-called "acute abdomen". Herein do we present a case in which dyspnea was the main symptom of colon perforation.

A 62-year-old woman was urgently admitted to the hospital due to dyspnea and nonspecific chest pain. On examination quite vesicular sound with crepitations and massive legs edema were noticed. Performed tests included: an ECG showing no features of fresh myocardial infarction, myocardial enzymes not specific to acute coronary syndromes, a chest X-ray revealing peribronchial thickening in the lower lobes, bilateral supradiaphragmatic signs of atelectasis, fibrosis and small areas of consolidation, blood levels of D-dimer heightened to 577 μg/l, CRP to 41 mg/l. Differential diagnosis consisted of a chest angio-CT, which ruled out pulmonary embolism, but confirmed the presence of pneumomediastinum. Further diagnostic process included an abdominal CT. A 70 millimeter parasigmoidal abscess was revealed with signs of gastrointestinal perforation. The patient underwent an emergency operation. After opening the peritoneum perforation of the sigmoid colon and an abscess in the sigmoid mesocolon lower to the perforation area were confirmed.

Perforation of the gastrointestinal tract may lead to pneumomediastinum and appearance of dyspnea.