title: Massive surgical emphysema after perineal proctosigmoidectomy.
abstract: An 83-year-old woman underwent an elective perineal proctosigmoidectomy (Altemeier procedure) for a rectal prolapse. On postoperative day 1, the patient presented with impressive subcutaneous emphysema involving the chest, neck and face without any other symptoms. A CT scan showed free air in the retroperitoneum, the intraperitoneal cavity, the mediastinum and a subcutaneous emphysema of the neck and the face. Air was also found around the coloanal anastomosis and an anastomotic leak was proven by rectal contrast agent. In this situation, a rectoscopy followed by a laparoscopy were immediately performed. The leak could not be visualised. Peritoneal lavage and drainage, followed by protective sigmoidostomy were carried out. After surgery, the follow-up was uneventful except a persistent but asymptomatic leak with a presacral cavity. The coloanal dehiscence was later proven in rectoscopy. Although sutured, it is still present and colostomy closure will eventually be possible in a few months.
authors.affiliation: Department of Surgery, Hôpital du Jura-Site de Delémont, Delémont, Switzerland.
authors.forename: Fiorenzo Valente Ernst Jakob
authors.initials: FV
authors.lastname: Angehrn
authors.affiliation: Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Silvio
authors.initials: S
authors.lastname: Däster
authors.affiliation: Department of Surgery, Hôpital du Jura-Site de Delémont, Delémont, Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Antonescu
mesh_terms: D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis*; D012809:Colon, Sigmoid / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013352:Subcutaneous Emphysema / Q000175:diagnosis / Q000209:etiology*