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World J Gastrointest Surg. Jun 27, 2026; 18(6): 119045
Published online Jun 27, 2026. doi: 10.4240/wjgs.119045
Subcutaneous emphysema due to rectal perforation: A case report
Yun-Ting Sun, Xiao-Wei Wang, Federico Maria Mongardini, Li-Mian Ling, Li-An Ma, Qian Xiao
Yun-Ting Sun, Xiao-Wei Wang, Federico Maria Mongardini, Li-Mian Ling, Qian Xiao, Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Yun-Ting Sun, Li-An Ma, Department of Anorectal Surgery, The Affiliated Yangming Hospital of Ningbo University, Yuyao 315400, Zhejiang Province, China
Xiao-Wei Wang, Department of Anorectal Surgery, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
Federico Maria Mongardini, Department of General, Mininvasive, Oncologic and Obesity Surgery, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
Qian Xiao, Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Zhejiang Provincial Clinical Research Center for Cancer, Cancer Center of Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Co-first authors: Yun-Ting Sun and Xiao-Wei Wang.
Co-corresponding authors: Li-An Ma and Qian Xiao.
Author contributions: Sun YT and Wang XW were primarily involved in literature retrieval, consultation and paper writing as the co-first authors of the paper; Mongardini FM and Ling LM searched the literature and other sources of information; Ling LM interpreted the data of the computed tomography images; Xiao Q and Ma LA conceived and designed the study as the co-corresponding authors. All authors have read and approved the final version to be published. This case report was completed through the equally important and complementary contributions of two authors. Xiao Q, as the attending physician, undertook full responsibility for patient clinical management, detailed data collection, and long-term clinical follow-up, ensuring the authenticity, accuracy, and ethical integrity of the clinical information. Ma LA, as the academic supervisor, designed the study framework, conducted a comprehensive literature review, and provided in-depth mechanistic analyses and interpretations, which greatly improved the scientific quality and academic value of the report. Given the interdisciplinary clinical and research nature of this case, both the frontline clinical perspective and the in-depth academic perspective are indispensable for responding to future academic inquiries and communications. Therefore, designating both authors as co-corresponding authors fairly and accurately reflects their joint intellectual leadership and shared responsibility for the integrity and conduct of the entire work.
Supported by National Natural Science Foundation of China, No. 82373234; and the Key R&D Program of Zhejiang Province, No. 2025C02065.
Informed consent statement: Written informed consent was obtained from the patient(s) for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Qian Xiao, Chief Physician, Principal Investigator, Professor, Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China.
qxiao3@zju.edu.cn
Received: January 19, 2026
Revised: March 6, 2026
Accepted: March 23, 2026
Published online: June 27, 2026
Processing time: 153 Days and 17 Hours
BACKGROUND
Rectal perforation leading to subcutaneous emphysema is relatively rare. This presentation is most frequently reported as a complication of endoscopic procedures. Consequently, its occurrence in spontaneous or non-endoscopic settings, particularly in elderly patients with subtle symptoms, represents a notable diagnostic dilemma.
CASE SUMMARY
This report describes a 94-year-old female patient who was admitted to hospital with lower abdominal pain. On physical examination, palpable subcutaneous emphysema was detected in the mandibular facial area, neck, chest, and abdomen. A computed tomography scan suggested the possibility of rectal perforation, along with multiple subcutaneous gas collections in the neck, chest, back, sacrococcygeal region, as well as around the esophageal vessels, mediastinum, and abdominal wall. An emergency exploratory laparotomy was decided upon. During the operation, a perforation in the middle segment of the rectum and pneumatosis retroperitonealis was found. The perforated segment of the rectum was resected surgically, and an end-sigmoid colostomy was fashioned in the left iliac fossa. Five months post-operation, the patient remained in a stable condition.
CONCLUSION
Subcutaneous emphysema in the elderly should prompt evaluation for colorectal perforation.
Core Tip: This case describes extensive subcutaneous emphysema as the primary sign of rectal perforation in an elderly patient. A literature review identified only eight similar non-endoscopic studies. The report underscores that in elderly patients, colorectal perforation may lack typical symptoms, and subcutaneous emphysema can be the leading clue, necessitating timely imaging and surgical evaluation.
