Surgical emphysema following therapeutic colonoscopy
A 60-year-old female presented to our endoscopy suite after being referred by her general practitioner for investigation of bleeding and passage of mucus per rectum. She also complained of tenesmus and reduced appetite but no weight loss. Her past medical history included being diagnosed with ulcerative colitis 26 years ago during her first pregnancy for which she was treated with steroids and has been relatively healthy since then. She had a previous colonoscopy in 2008, following a positive bowel screening. This colonoscopy showed quiescent colitis confirmed by biopsy. During the present colonoscopy, she had biopsies taken from her rectum, sigmoid, descending and ascending colon given the findings of pseudopolyps.\nAfter her procedure she complained of swelling in her neck. This was not accompanied by shortness of breath, chest pain or abdominal pain. On examination, her oxygen saturation was 99% on room air, with normal respiratory and heart rate. Her respiratory examination was normal and her abdomen was soft and non-tender. She had marked crepitus over her clavicles, supraclavicular fossa and most of her neck. Her erect chest X-ray revealed air under both hemidiaphragms and significant pneumomediastinum (Fig. ). A computed tomography (CT) scan of her chest, abdomen and pelvis was requested. This CT-scan revealed very extensive spreading of surgical emphysema in the retroperitoneum, extending into the mediastinum with small volumes of free intraperitoneal gas (Figs –).\nThe patient was admitted and managed conservatively. This consisted of keeping her nil by mouth for 24 h, intravenous fluids and antibiotics. Her cervical emphysema gradually resolved and she was discharged 72 h after presentation without any surgical intervention.