title: [Rectum tumor diagnosed by subcutaneous emphysema of the chest].
abstract: BACKGROUND
  Various benign and malignant thoracic or abdominal diseases can cause subcutaneous emphysema on the chest, pneumomediastinum or pneumopericardium. To date only 7 cases have been reported on perforation of the sigmoid colon or the rectum presenting with these rare symptoms.
  
  
  METHODS
  We report a case of a 72-year-old woman who presented with thoracic and cervical subcutaneous emphysema, pneumomediastinum and pneumopericardium. Further examination revealed that this was caused by a rectal tumor causing large bowel obstruction and a consequent perforation of the transverse colon. Due to the patient's old age, poor health and the special anatomic situation after previous laparotomies, she presented with atypical symptoms.
  
  
  CONCLUSIONS
  Subcutaneous emphysema of the chest, pneumomediastinum and pneumopericardium are uncommon symptoms and can be a real challenge in diagnosis. Especially in old patients with significant past medical history, life-threatening conditions present misleadingly with vague clinical symptoms. In case of these patients it is important to remember that even cardiopulmonary symptoms such as pneumomediastinum, pneumopericardium or subcutaneous emphysema of the chest can be signs of severe diseases in the abdomen.
authors.affiliation: Petz Aladár Megyei Oktató Kórház, Sebészeti Centrum, 9024 Gyor, Vasvári u. 2. kajda@freemail.hu
authors.forename: Nóra
authors.initials: N
authors.lastname: Hajdú
authors.forename: Péter
authors.initials: P
authors.lastname: Zsoldos
authors.forename: György
authors.initials: G
authors.lastname: Neuberger
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000150:complications / Q000209:etiology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D008478:Mediastinal Emphysema / Q000209:etiology; D011026:Pneumopericardium / Q000209:etiology; D012004:Rectal Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D013352:Subcutaneous Emphysema / Q000209:etiology*; D016896:Treatment Outcome