Benign subcutaneous emphysema: A case report with bite.
BACKGROUND
Subcutaneous emphysema is the presence of air/gas within the subcutaneous tissue plane. Though there are numerous causative factors, benign subcutaneous emphysema is rare.


METHODS
We report a very rare case of benign subcutaneous emphysema following an insect bite on the forearm of a 48-year old man. The puncture area was erythematous and the emphysema extended to the whole arm, axilla and superior mediastinum. Despite, conservative management, the patient had residual discomfort and erythema around the puncture site. Surgical debridement resulted in resolution of symptoms.


CONCLUSIONS
Subcutaneous emphysema affecting an isolated limb is extremely rare. It is vital to differentiate it from life-threatening soft-tissue infections secondary to a gas-forming organism. Immunodeficiency states are key factors in the development and the outcomes of patients with subcutaneous emphysema. Medical management successfully resolves symptoms in the majority of cases. However, surgical debridement of the puncture site and surrounding fibrotic tissue has been advocated for those with persistent symptoms.


CONCLUSIONS
This case highlights a rare cause of benign subcutaneous emphysema, highlighting key issues surrounding its management for a successful outcome.
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
V E
VE
Onwochei
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland. Electronic address: kellym11@tcd.ie.
M E
ME
Kelly
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
R
R
Lyons
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
W
W
Khan
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
K M
KM
Barry
Benign subcutaneous emphysema; Insect bite; Management