title: Pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and extensive subcutaneous emphysema in a patient with ulcerative colitis: A case report.
abstract: BACKGROUND
  Pneumo-mediastinum and subcutaneous emphysema are rare presentations of lower gastrointestinal tract perforation.
  
  
  METHODS
  We are presenting the case of a middle aged man diagnosed with UC who presented with dyspnea and subcutaneous emphysema, attributed to multiple perforations including the stomach and colon.
  
  
  METHODS
  Patients with ulcerative colitis (UC) are at an increased risk of perforations due to friability of colonic mucosa given the chronic inflammation and relapsing flares. Chronic use of steroids further predisposes to stress ulcers. These pathologies sometimes coexist and identification of each is crucial for the appropriate treatment plan.
  
  
  CONCLUSIONS
  The case allows for a learning opportunity focusing on coexisting pathologies which may be differentiated based on anatomical knowledge and patient presentation.
authors.affiliation: Medical College, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: usmantsiddiqui@hotmail.com.
authors.forename: Usman T
authors.initials: UT
authors.lastname: Siddiqui
authors.affiliation: Medical College, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hira
authors.initials: H
authors.lastname: Shahzad
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Asad Jamil
authors.initials: AJ
authors.lastname: Raja
keywords: Inflammatory bowel disease; Pneumoperitoneum; Pneumoretroperitoneum; Subcutaneous emphysema; Ulcerative colitis