This patient with Crohn's disease underwent endoscopic balloon dilatation of an ileocolic stricture, and shortly thereafter developed subcutaneous emphysema in the soft tissues of her face, neck, and chest wall. Clinical evaluation and imaging revealed peritonitis from perforated bowel. She underwent laparotomy and bowel resection and recovered well. Subcutaneous emphysema in the head and neck from perforated bowel is a rare but recognized presentation of viscus perforation.
JanczakDZiomekADorobiszTDorobiszKJanczakDPawłowskiW, et al.Subcutaneous emphysema of the neck, chest, and abdomen as a symptom of colonic diverticular perforation into the retroperitoneum. Polish Journal of Cardio-Thoracic Surgery. 2016;1:55-57.
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KippleJC. Bilateral tension pneumothoraces and subcutaneous emphysema following colonoscopic polypectomy: A case report and discussion of anesthesia considerations. AANA J (Am Assoc Nurse Anesth). 2010;78(6):462-467.
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LeeMJConnellyTM. Head and neck subcutaneous emphysema, a rare complication of iatrogenic perforation during colonoscopy: management review of reported cases from 2000-2016. Expet Rev Gastroenterol Hepatol. 2017;11(9):849-856.
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