Pneumomediastinum Due to Traumatic Rectal Perforation

• Published in: American journal of respiratory and critical care medicine Vol. 201; no. 5; pp. e15 - e16
• Main Authors: Bots, Eva M T, Hoek, Rogier A S
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.03.2020
• Subjects: Adult; Emphysema; Fractures, Bone - complications; Humans; Intestinal Perforation - complications; Intestinal Perforation - diagnosis; Intestinal Perforation - surgery; Male; Mediastinal Emphysema - diagnostic imaging; Mediastinal Emphysema - etiology; Pelvic Bones - injuries; Postoperative period; Rectal Diseases - complications; Rectal Diseases - diagnosis; Rectal Diseases - surgery; Rectum - injuries; Subcutaneous Emphysema - diagnostic imaging; Subcutaneous Emphysema - etiology; Thoracic surgery; Tomography; Wound healing; Wounds, Penetrating - complications
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201902-0276IM

Bots and Hoek present a case of a 34-year-old smoker who was presented at the emergency department after a penetrating trauma by the arm of an excavator, followed by entrapment of the patient. An open pelvic fracture was diagnosed, for which he underwent surgery. A deep defect of the left thigh and left inguinal area was noticed, for which a debridement was performed. Physical examination was otherwise unremarkable, and computed tomography scan of thorax and abdomen showed no abnormalities other than minimal free abdominal air at the fracture site. On postoperative Day 2, the patient developed rapid onset of subcutaneous emphysema. On postoperative Day 6, the patient complained about fecal contamination in his pelvic wound. In their patient, an extraperitoneal perforation was diagnosed, but pneumoretroperitoneum was absent. In retrospect, a miniscule pneumoperitoneum could be identified that was initially attributed to the pelvic wound. They believed that air traveled retroperitoneally to the thorax and neck because of anatomical fascial continuity.