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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of subcutaneous emphysema of the left lower extremity secondary to perforations of the rectum ,nd sigmoid colon are presented. Although this is an extremely rare syndrome, the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical and postmortem examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma to the chest or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the physician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities.
Dis Colon Rectum
PMID:Subcutaneous emphysema of the lower extremity of gastrointestinal origin. 69 26

A case of retroperitoneal, mediastinal, and subcutaneous emphysema following rectal surgery is described. This complication has not been reported in medical literature. Treatment was based on the fear of a more extensive and irreversible situation, because on the basis of the single case, it could not be demonstrated that the intestinal gas was not associated with infection.
Dis Colon Rectum
PMID:Subcutaneous emphysema, pneumoretroperitoneum, and pneumomediastinum following rectal surgery: report of a case and review of the literature. 99 17

Retroperitoneal abscesses may develop insidiously, resulting in delayed diagnosis with significant morbidity and mortality. Subcutaneous emphysema of the thigh may be a late manifestation of this process, and often heralds a poor prognosis because of associated myonecrosis and fulminant sepsis. The presentation and clinical course of such a patient is summarized, and the relevant anatomy of the retroperitoneal spaces that predisposes to this condition is described.
Dis Colon Rectum 1986 Jul
PMID:Retroperitoneal perforation of the appendix presenting as subcutaneous emphysema of the thigh. 372 Apr 59

A case of subcutaneous emphysema and pneumothorax secondary to a diagnostic colonoscopy is presented. While 11 cases of retroperitoneal emphysema due to colonoscopy were identified in the literature, there are only two further reports of pneumothorax. Possible etiologic and therapeutic aspects are discussed.
Dis Colon Rectum 1986 Feb
PMID:Subcutaneous emphysema and pneumothorax complicating diagnostic colonoscopy. 394 23

Retroperitoneal and mediastinal emphysema as a complication of colonoscopy, though infrequent, may occur. It is important to realize that this can be a benign clinical condition that will resolve with conservative management. A case of retroperitoneal emphysema after routine colonoscopy is reported with a review of literature and a brief discussion.
Dis Colon Rectum 1982 Mar
PMID:Retroperitoneal and mediastinal emphysema as a complication of colonoscopy. 706 53

A 57-year-old man administered an enema to himself, preparatory to intravenous pyelography. He left after the films were taken and could not be reached when retroperitoneal emphysema was detected, He was located 12 days later and found in good health. Abdominal x-ray films and rectosigmoidoscopy were normal. The patient refused further investigations. It is assumed that a small perforation occurred at the rectosigmoid junction during the self-administration of the enema. This assumption is borne out by the pattern of air distribution. The total absence of complaints and physical signs is unusual, although not unique; similar cases have been reported previously. The cause of such injury is mechanical, since the high pressures necessary to rupture the rectum are not usually attained in ordinary enemas. Caution is called for in intrarectal instrumentation, especially in older patients.
Dis Colon Rectum 1981 Oct
PMID:Asymptomatic rectal perforation with retroperitoneal emphysema. 729 65

A review of the perioperative morbidity and mortality and long-term survival in elderly and high-risk patients with colorectal neoplasia was undertaken. Elderly high-risk patients with localized disease were compared with those with advanced disease. Over a five-year period, 82 high-risk (at least one major organ system disease), or elderly (age > or = 70 years) patients underwent an operation for colorectal neoplasia. Overall, 43 of 82 (52 percent) had advanced disease (obstruction, perforation, hemorrhage, or metastatic disease), while 39 of 82 (48 percent) had localized disease. The mean age of all patients was 78.2 years. Preoperative comorbid diseases included: coronary atherosclerosis, 59 (72 percent); previous myocardial infarction, 17 (21 percent); previous arrhythmia, 10 (12 percent); emphysema, 32 (39 percent); renal failure, 6 (7 percent); and cirrhosis, 3 (4 percent). At the time of surgery, 26 patients (32 percent) had metastatic disease. Six patients (7 percent) died in the perioperative period. The presence of advanced neoplasia did not significantly affect 30-day mortality. There was no difference in major morbidity between patients operated on for localized and for advanced disease. The mean actuarial 18-month survival was less for patients with advanced disease (P < 0.05). Sixty-eight patients (83 percent) are alive at a follow-up of 17.7 +/- 29 months postoperatively. The morbidity and mortality associated with resection of colorectal neoplasia in high-risk elderly patients are acceptable even in the presence of advanced disease. In select patients, resection offers the best palliation and may improve the quality of remaining life.
Dis Colon Rectum 1993 Feb
PMID:Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified? 842 20

Since its introduction into clinical medicine, flexible fiberoptic colonoscopy has had a great impact on diagnosis and management of diseases of the colon and rectum. There are three mechanisms responsible for colonoscopic perforation: specifically, mechanical perforation directly from the colonoscope or a biopsy forceps, barotrauma from overzealous air insufflation, and, finally, perforations that occur during therapeutic procedures. Perforation of the colon, which requires surgical intervention more frequently than bleeding, occurs in less than 1 percent of patients undergoing diagnostic colonoscopy and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal, dilation of strictures, or laser ablative procedures. Management of colonic perforation secondary to colonoscopy remains a controversial issue in that it can be effectively managed by operative and nonoperative measures. If a perforation does occur, signs and symptoms that the patient will experience will be related to both the size and site of the perforation, adequacy of the bowel preparation, amount of peritoneal soilage, underlying colonic pathology (where a thin walled colon from colitis or ischemia, for example, may result in a larger perforation than a healthy colon), and, finally, overall clinical condition of the patient. Radiology often establishes diagnosis. Plain films of the abdomen and an upright chest x-ray may reveal extravasated air confined to the bowel wall, free intraperitoneal air, retroperitoneal air, subcutaneous emphysema, or even a pneumothorax. A localized perforation may demonstrate lack of pneumoperitoneum. Some surgeons recommend surgery for all colonoscopic perforations; however, there does appear to be a role for conservative management in a select group of patients such as those with silent asymptomatic perforations and those with localized peritonitis without signs of sepsis that continue to improve clinically with conservative management. Finally, conservative management works well in those patients with postpolypectomy coagulation syndrome. Surgery is most definitely indicated in the presence of a large perforation demonstrated either colonoscopically or radiographically and in the setting of generalized peritonitis or ongoing sepsis. The presence of concomitant pathology at time of colonoscopic perforation such as a large sessile polyp likely to be a carcinoma, unremitting colitis, or perforation proximal to a nearly obstructing distal colonic lesion may force immediate surgery. Finally, in the patient who deteriorates with conservative management, one should proceed to surgery.
Dis Colon Rectum 1996 Nov
PMID:Colonoscopic perforations. Etiology, diagnosis, and management. 891 45

This article presents the first known case of pneumorrhachis (spinal air), pneumomediastinum, pneumopericardium, pneumoretroperitoneum, and subcutaneous emphysema after proctocolectomy for ulcerative colitis. We review the patient's medical history, clinical and laboratory findings, radiographic data, and operative records, as well as the relevant literature. We describe the case of a young male with ulcerative colitis who developed pneumorrhachis, subcutaneous emphysema, pneumoretroperitoneum, pneumomediastinum, and pneumopericardium after a proctocolectomy with ileal pouch-anal anastomosis. Unlike the case we report, previously described episodes of pneumomediastinum and subcutaneous emphysema in patients with ulcerative colitis developed before operative intervention. We offer possible explanations for these unusual complications based on analysis of this case and thorough review of the literature.
Dis Colon Rectum 2002 Apr
PMID:Pneumorrhachis, subcutaneous emphysema, pneumomediastinum, pneumopericardium, and pneumoretroperitoneum after proctocolectomy for ulcerative colitis: report of a case. 1200 44

A 50-year-old woman with breast carcinoma metastases in the left supraclavicular region was treated because of free air in the mediastinum, around the heart and vascular pedicle, below the diaphragmatic dome, and subcutaneous neck and supraclavicular emphysema, without radiologic signs of pneumothorax. Diverticulosis of the colon and an occult perforation of the diverticulum in the retroperitoneal region of the colon were diagnosed. The patient was treated by segmental resection of the colon with anastomosis, drainage of the abdominal cavity, and antibiotics. To our knowledge, this is the only report in the literature about pneumopericardium caused by peridiverticulitis of the colon.
Dis Colon Rectum 2004 May
PMID:Pneumomediastinum, pneumopericardium, and pneumoperitoneum caused by peridiverticulitis of the colon: report of a case. 1499 17


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