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Colonic perforation revealed by massive subcutaneous emphysema.
Sylvain Diop1, Mikhael Giabicani2, Stéphane Legriel2
1Medico-Surgical Intensive Care Department, Versailles Hospital, Le Chesnay Cedex, Paris, France.
International Journal of Critical Illness and Injury Science
|August 16, 2021
Summary
A liver abscess led to septic shock in an 82-year-old woman. Post-surgery, she developed extensive subcutaneous emphysema (SE), later found to be caused by perforated peritonitis.
Area of Science:
- Medicine
- Surgery
- Critical Care
Background:
- Liver abscesses can lead to severe sepsis and septic shock.
- Subcutaneous emphysema (SE) is the presence of air in the subcutaneous tissues.
- Massive SE can be a sign of serious underlying pathology.
Observation:
- An 82-year-old female presented with septic shock from a liver abscess, requiring emergency laparotomy.
- Following surgery, she developed extensive subcutaneous emphysema (SE) from the abdomen to the head.
- No immediate cause for SE was apparent in the early postoperative period.
Findings:
- A second laparotomy revealed perforated peritonitis as the underlying cause of the SE.
- Subcutaneous emphysema was a rare but critical manifestation of the perforated peritonitis.
- Microbiological sampling from the initial laparotomy provided etiological data.
Implications:
- Critical care physicians must consider perforated peritonitis in patients with unexplained massive SE.
- Timely diagnosis and management of SE secondary to peritonitis are crucial for patient survival.
- This case underscores the importance of recognizing rare presentations of common surgical emergencies.
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