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Massive subcutaneous emphysema following colonoscopy.

F Humphreys, K A Hewetson, A W Dellipiani

    Endoscopy
    |July 1, 1984
    PubMed
    Summary
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    Massive subcutaneous emphysema after colonoscopic polypectomy suggests a retroperitoneal perforation. This complication typically requires conservative management, unlike intraperitoneal perforations needing surgery.

    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Medical Imaging

    Background:

    • Colonoscopic polypectomy is a common procedure for removing colon polyps.
    • Colonic perforation is a rare but serious complication, occurring in approximately 0.1% of cases.
    • Perforations can be intraperitoneal or retroperitoneal, each with distinct clinical presentations and management strategies.

    Observation:

    • A case of massive subcutaneous emphysema following colonoscopic polypectomy is presented.
    • Subcutaneous emphysema, particularly when extensive or associated with pneumoscrotum, is a key indicator of retroperitoneal perforation.
    • This contrasts with intraperitoneal perforations, which often present with acute abdominal signs requiring immediate surgical intervention.

    Findings:

    • Retroperitoneal colonic perforation following polypectomy can lead to significant subcutaneous emphysema.

    Related Experiment Videos

  • Conservative management is often successful for retroperitoneal perforations presenting with subcutaneous emphysema.
  • Plain X-rays can be valuable in differentiating between intraperitoneal and retroperitoneal perforations, aiding in treatment decisions.

    • Implications:

    • Recognizing subcutaneous emphysema as a sign of retroperitoneal perforation is crucial for appropriate patient management.
    • Conservative treatment strategies for retroperitoneal perforations can avoid unnecessary surgical exploration.
    • Further research into the diagnostic accuracy of imaging modalities for colonic perforation is warranted.