title: Widespread surgical emphysema following trivial injury to the hand.
abstract: A 23-year-old glazer presented to the A&E department with pain in his left arm following a 2 mm puncture injury to his left thenar eminence. Examination showed crepitus throughout the arm and over the chest wall. Plain X-rays confirmed extensive surgical emphysema but no evidence of pneumothorax. Clinical observations and laboratory markers for infection were normal. The patient was prescribed broad spectrum antibiotics for presumed gas-producing organism infection. After 24 h cultures returned negative and no other signs of infection were detected. Treatment was discontinued and the patient was allowed home. Several days later he experienced severe diarrhoea and as a result required time off work. No cause was found on investigation. We postulate a benign aetiology for the surgical emphysema in this case. In future it may be possible to recognise benign surgical emphysema at presentation and avoid prescribing unnecessary antibiotics.
authors.affiliation: East Sussex Hospitals NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: William Kristian Miles
authors.initials: WK
authors.lastname: Gietzmann
authors.affiliation: East Sussex Hospitals NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: Joana
authors.initials: J
authors.lastname: Mousinho
authors.affiliation: East Sussex Hospitals NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: Karuna
authors.initials: K
authors.lastname: Tandon
authors.affiliation: East Sussex Hospitals NHS Trust, Eastbourne, East Sussex, UK.
authors.forename: Samuel
authors.initials: S
authors.lastname: Turner
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004646:Emphysema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006230:Hand Injuries / Q000150:complications*; D006801:Humans; D008297:Male; D018461:Soft Tissue Infections / Q000175:diagnosis; D014950:Wounds, Penetrating / Q000150:complications*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents