Subcutaneous Emphysema in Spontaneous Acute Colonic Rupture Mimicking an Acute Traumatic Injury

Subcutaneous emphysema often results from traumatic injuries such as pneumothorax or traumatic perforation of the bowel. In this case report, however, the authors present subcutaneous emphysema that resulted from a spontaneous colonic perforation that disguised itself as a traumatic injury in an elderly patient who was presumed to have sustained a traumatic injury.  In this case, an 88-year-old male presented to the emergency department via trauma alert after being found unresponsive on the floor with extensive subcutaneous emphysema of his hips, thighs, chest, abdomen, and cervical area. He was intubated prior to arrival and had bilateral tube thoracostomies placed shortly after arrival. After stabilization, computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis was performed, and he was found to have an acute colonic perforation, which resulted in extensive subcutaneous emphysema that mimicked the presumed traumatic injury on presentation. This case highlights the importance of keeping a broad differential diagnosis in patients with extensive subcutaneous emphysema. In this case, the patient presented with a presumed acute traumatic injury, though he was ultimately diagnosed with acute colonic perforation.