Sun YT, Wang XW, Mongardini FM, Ling LM, Ma LA, Xiao Q. Subcutaneous emphysema due to rectal perforation: A case report. World J Gastrointest Surg 2026; 18(6): 119045 [DOI: 10.4240/wjgs.119045]
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08157207
Submitted on:
July 02, 2026, 08:58
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Reader Comments:
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gastrointestinal oncology
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The reviewer declares no conflict of interest.
Scientific quality
Grade A
Language quality
Grade A
Reader comments
I would like to congratulate the authors on publishing this interesting and clinically valuable case report. The manuscript presents a rare case of rectal perforation manifesting as extensive subcutaneous emphysema, which provides important insights for clinical practice.
This article is well organized, clearly written, and supported by high-quality imaging and intraoperative findings. One of the major strengths of this report is its emphasis on the atypical clinical presentation in elderly patients, particularly in the absence of classic signs of peritonitis. This finding offers valuable diagnostic guidance for surgeons, emergency physicians, and clinicians involved in the management of acute abdominal conditions.In addition, the literature review further strengthens the clinical value of this manuscript by summarizing previously reported non-endoscopic cases and highlighting the rarity of this condition. The discussion regarding the potential anatomical pathways of gas dissemination from rectal perforation to subcutaneous tissues is also informative and helps improve understanding of the underlying disease mechanism.
A minor suggestion would be to further expand the discussion on the differential diagnosis of unexplained subcutaneous emphysema in elderly patients, as well as the clinical decision-making process for early diagnosis and surgical intervention. This may further enhance the educational and practical value of the report.
Overall, this is a well-written, informative, and meaningful case report with important clinical implications. It contributes valuable evidence for improving the early recognition and timely management of atypical rectal perforation.