title: Massive surgical emphysema following transanal endoscopic microsurgery.
abstract: We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed massive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery (TEM) procedure for a rectal intramucosal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal contrast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO2 gas in the rectum during the TEM-procedure. Conservative treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we expect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice.
authors.affiliation: Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh, Department of Surgical Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands.
authors.forename: Geert Aam
authors.initials: GA
authors.lastname: Simkens
authors.affiliation: Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh, Department of Surgical Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.affiliation: Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh, Department of Surgical Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands.
authors.forename: Misha Dp
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh, Department of Surgical Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands.
authors.forename: Ignace Hjt
authors.initials: IH
authors.lastname: de Hingh
keywords: Colorectal neoplasms; Gastrointestinal endoscopy; Intraperitoneal emphysema; Microsurgery; Retropneumoperitoneum; Subcutaneous emphysema; Transanal endoscopic microsurgery